DEVELOPMENT This subcourse is approved for resident and correspondence course instruction. It reflects the current thought of the Academy of Health Sciences and conforms to printed Department of the Army doctrine as closely as currently possible. Development and progress render such doctrine continuously subject to change. ADMINISTRATION Students who desire credit hours for this correspondence subcourse must enroll in the subcourse. Application for enrollment should be made at the Internet website: http://www.atrrs.army.mil. You can access the course catalog in the upper right corner. Enter School Code 555 for medical correspondence courses. Copy down the course number and title. To apply for enrollment, return to the main ATRRS screen and scroll down the right side for ATRRS Channels. Click on SELF DEVELOPMENT to open the application; then follow the on-screen instructions. For comments or questions regarding enrollment, student records, or examination shipments, contact the Nonresident Instruction Branch at DSN 471-5877, commercial (210) 221-5877, toll-free 1-800-344-2380; fax: 210-221-4012 or DSN 471-4012, e-mail accp@amedd.army.mil, or write to: NONRESIDENT INSTRUCTION BRANCH AMEDDC&S ATTN: MCCS-HSN 2105 11TH STREET SUITE 4191 FORT SAM HOUSTON TX 78234-5064 Be sure your social security number is on all correspondence sent to the Academy of Health Sciences. CLARIFICATION OF TERMINOLOGY When used in this publication, words such as "he," "him," "his," and "men" 'are intended to include both the masculine and feminine genders, unless specifically stated otherwise or when obvious in context. USE OF PROPRIETARY NAMES The initial letters of the names of some products may be capitalized in this subcourse. Such names are proprietary names, that is, brand names or trademarks. Proprietary names have been used in this subcourse only to make it a more effective learning aid. The use of any name, proprietary or otherwise, should not be interpreted as endorsement, deprecation, or criticism of a product; nor should such use be considered to interpret the validity of proprietary rights in a name, whether it is registered or not.

TABLE OF CONTENTS Lesson INTRODUCTION 1 DISEASE TRANSMISSION AND STANDARD CLINICAL PROCEDURES Section I. Microbiology and Disease Transmission Section II. Procedures for Protection Against Infection Exercises 2 STERILIZATION AND DISINFECTION Section I. Sterilization, Storage, and Disposal Section II. Disinfection Exercises 3 DRUGS IN THE DENTAL CLINIC Section I. Basic Concepts Section II. Common Drugs Section III. Administrative Considerations Exercises APPENDIX, Drugs Commonly Used in Dentistry 3-1--3-5 3-6--3-27 3-28--3-32 2-1--2-15 2-16--2-22 1-1--1-8 1-9--1-14 Paragraphs



Appendix. ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL SUBCOURSE MD0509 INFECTION CONTROL AND DRUGS IN THE DENTA CLINIC INTRODUCTION Dental specialists assist dental officers in many aspects of patient care.S. marking your answers in this booklet. Subcourse Components: The subcourse instructional material consists of three lessons And an appendix as follows: Lesson 1. Dental assistants also need to be familiar with the various drugs involved in dental therapy. MD0509 ii . --After completing each set of lesson exercises. even though dental officers are solely responsible for prescribing the drugs. One of the purposes of this subcourse is to provide you with knowledge concerning disease transmission. Lesson 2. If you have answered an exercise incorrectly. compare your answers with those on the solution sheet that follows the exercises. together with their uses. --Complete the subcourse lesson by lesson. Drugs in the Dental Clinic. Drugs Commonly Used in Dentistry Here are some suggestions that may be helpful to you in completing this subcourse: --Read and study each lesson carefully. disposal of regulated waste. Disease Transmission and Standard Clinical Procedures. check the reference cited after the answer on the solution sheet to determine why your response was not the correct one. storage of sterile items. individual measures for protection against infection.CORRESPONDENCE COURSE OF THE U. and chemical disinfection of equipment. After completing each lesson. A very important part of patient care is infection control and maintaining a high level of cleanliness in the dental treatment area. Sterilization and Disinfection. Lesson 3. and drugs commonly used in dentistry are described. Terms related to drugs are reviewed. work the exercises at the end of the lesson. methods of sterilization.

you will be awarded 10 credit hours.usapa.pdf.army. The DA PAM is available at the following website: http://www. MD0509 iii .Credit Awarded: Upon successful completion of the examination for this subcourse.mil/pdffiles/p350-59. you must be officially enrolled and complete an examination furnished by the Nonresident Instruction Branch at Fort Sam Houston. Texas. You can enroll by going to the web site http://atrrs. To receive credit hours. A listing of correspondence courses and subcourses available through the Nonresident Instruction Section is found in Chapter 4 of DA Pamphlet 350-59. Army Correspondence Course Program Catalog.mil and enrolling under "Self Development" (School Code 555).army.

Identify types of diseases that can be transmitted in a dental clinic. complete the exercises at the end of this lesson. Identify the defense mechanisms of the body. Identify characteristics of bacteria. Identify the steps of the three-hand washing technique required of all dental health care workers. Identify precautionary measures taken to avoid cross infection. 1-4. These exercises will help you to achieve the lesson objectives. TEXT ASSIGNMENT LESSON OBJECTIVES 1-2. you should be able to: 1-1. 1-6. 1-5. fungi. After completing this lesson. Identify the importance of environmental cleanliness for infection control. 1-3. MD0509 1-1 . SUGGESTION After completing the assignment.LESSON ASSIGNMENT LESSON 1 Disease Transmission and Standard Clinical Procedures Paragraph 1-1 through 1-14. and viruses (microorganisms).

they can sometimes be seen by the unaided eye. Microbiology is the study of microorganisms. whereas many fungi grow best at 77ºF (25ºC).LESSON 1 DISEASE TRANSMISSION AND STANDARD CLINICAL PROCEDURES Section I. However. A few bacilli produce spores that are highly resistant to harsh environmental conditions. fungi. clusters (staphylo). fungi. 1-2. MD0509 1-2 . when bacteria or fungi grow into a mass. Bacteria. such as moderately high temperatures and certain chemicals. MICROBIOLOGY a. MICROBIOLOGY AND DISEASE TRANSMISSION 1-1. and some fungi grow well at 95ºF (35ºC). and viruses. bacilli tend to occur in a wide variety of sizes and forms. They exist in almost every environment on earth. and viruses. The word "micro" implies that microorganisms are extremely small and not visible to the unaided eye. In addition to appearing in various specific arrangements. The gram stain is often used to aid in differentiating bacteria. Three types of microorganisms are bacteria. See figure 1-1. Viruses and a few bacteria require living tissue cells to support their growth and reproduction. and spirochete or spirilla (corkscrew). Shapes of bacteria. depending on the specific microbe. b. BACTERIA The three basic shapes of bacteria are coccus (spherical). also called germs or microbes. Cocci may be arranged in chains (strepto). or pairs (diplo). Most bacteria and fungi are capable of growing in or on common laboratory culture media (nutrients). Microorganisms. viruses in tissue culture. See figure 1-2. including bacteria. Figure 1-1. are a common cause of disease. bacillus (rod like).

Compared to bacteria and fungi. Types of fungi. Bacterial cell arrangements. 1-4. MD0509 1-3 . See figure 1-3. VIRUSES Viruses that infect humans have a variety of shapes and structures ranging from rod like.Figure 1-2. Figure 1-3. Molds usually have branching filaments on which various types of spores are produced. See figure 1-4. 1-3. Fungi are usually much larger than bacteria. Viruses can be observed only by the use of an electron microscope. viruses are extremely small. or oval cells that reproduce by budding. Yeasts are usually large. FUNGI Two types of fungi are molds and yeasts. round. to spherical. to oval.

Shapes of viruses. improper diet. healthy adult mouth that has a highly varied and concentrated population. account for only a small fraction of the total count. Infections may be transmitted via contaminated food or other entry into the gastrointestinal tract. Infections may be transmitted via airborne droplet into the respiratory tract. such as the normal. may also be present. such as Candida albicans. influenza viruses.Figure 1-4. Examples include the common cold viruses. and tuberculosis bacteria. b. MICROBES IN THE MOUTH Microbes normally inhabit certain parts of the body. or periodontal or other disease upsets this environment. MD0509 1-4 . Facultative streptococci (bacteria that thrive either in the presence or the absence of oxygen) are the most numerous. Through the Respiratory Tract. Examples include dysentery and diarrhea. Various normal microbe populations safely exist in an oral environment until something such as antimicrobial therapy. TRANSMISSION ROUTES FOR INFECTIONS a. 1-6. plaque and the gingival sulcus contain one hundred times this number. Through the Gastrointestinal Tract. poor oral hygiene. although often implicated in dental caries activity. 1-5. Although the types of bacteria are different. They account for perhaps 50 percent of the total count. Lactobacilli. The saliva from the dorsal surface of the tongue contains about 750 million bacteria per milliliter (about 20 drops of saliva). Oral spirochetes are anaerobic (require the absence of oxygen) and inhabit the gingival sulcus. Certain fungi.

and pyrodoxine). The mucous membrane of the eye is still another defense mechanism. The Skin and the Respiratory Tract. Fixed phagocytic cells (which line vascular and lymph channels). d. The Immune System. ingest invading agents in tissues. a. The immune system is a complex phenomenon involving antigens and antibodies. Passive immunity is achieved when preformed antibodies are administered.0 to 3. The alimentary canal is a defense mechanism that destroys harmful bacteria in the stomach by gastric acids (pH 1. While white blood cells circulate throughout the body. Antibodies are substances manufactured by the body in response to an antigen. as well as wandering phagocytic cells. The skin acts as the first line of defense by being bactericidal and fungicidal through sebaceous secretion of fatty acids and by the presence of native bacteria. The Eye.5). These preformed antibodies are manufactured by another person or an animal that was previously actively immunized against a specific antigen. Direct Personal Contact. Active and passive are two types of immunities. the abundant population of microorganisms existing in the lower colon produces essential vitamins (such as vitamin K. Antigens are foreign proteins that elicit immune reactions in the body. MD0509 1-5 . Opportunistic Microorganisms. b. Normal flora microbes may become opportunistic pathogens under certain circumstances. The tortuous passage of air through the nasal turbinate effectively filters objects heavier than air (for example. White Blood Cells. DEFENSE MECHANISMS OF THE BODY The body has developed defense mechanisms to control and to cope with the constant attack of microorganisms. Cilia in the bronchi act in a flagellating (sweeping) manner to expel foreign material and to bring it to the throat where it is swallowed or expectorated. 1-7. Examples include the bacteria causing dental caries and periodontal disease. c. d. The Alimentary Canal. Active immunity is achieved when a person manufactures his own antibodies in response to an antigen. Examples include hepatitis and syphilis. In addition. biotin.c. The respiratory tract acts as an efficient air filter. Another defense mechanism is the phagocytic action of white blood cells and macrophages in the reticuloendothelial system (RES). It resists infection by lacrimal secretions (tearing) containing wandering phagocytes and lysozyme (an enzyme which destroys bacteria). indirectly supplementing other defense mechanisms. e. dust). The antibody combines with the antigen to remove or deactivate it. they concentrate at sites of serious infection and inflammation. Infections may be transmitted via direct personal contact.

Therefore. The tongue is the most frequent site for these lesions. Two types of distinguishable hepatitis are Hepatitis A and Hepatitis B. TYPES OF DISEASE TRANSMITTED The dental specialist must be aware of some diseases that can be transmitted in the dental clinic. even in mild cases. New antigenic types are produced by mutation of the viruses. Tuberculosis is spread by an airborne droplet. Hepatitis B is spread by injectables and instruments that have come in contact with contaminated blood or serum. it is difficult for a vaccine to be completely effective. It has an incubation period of about 30 days. Being aware of these diseases will make sterilization and disinfection procedures more meaningful. Inactive tuberculosis occurs when the bacteria are walled off by the fibrous tissue. each of which may have many antigenic types. This is a venereal disease caused by a spirochete. d. Since the spirochete is anaerobic. A positive test result should always be reported to the dental or medical officer. Influenza. Tuberculosis of the oral mucosa occurs if wounds or erosions become infected by tubercle bacilli contained in the sputum. Hepatitis is a disease caused by a virus that. The risk of infection exists between patients and between the patient and the dental specialist. Tuberculosis.1-8. liver necrosis is common. The common cold is caused by two or three different viruses. This is a venereal disease caused by a gram-negative diplococcus. damages the liver. Clinically. b. In severe cases. It has a much longer incubation period (perhaps several months) than Hepatitis A. A positive antibody test merely indicates present or previous infection with the tuberculosis bacteria. and drug-resistant forms are appearing. Primary infection is by genital contact. Gonorrhea. Tuberculosis is becoming more common. contact is made by an open wound or by contaminated instruments penetrating the oral mucosa. a. Hepatitis A is usually spread by fecal contamination of food or drink. Secondary infection is possible via the hands or by contaminated instruments. Hepatitis. the common flu. It may live long enough to effect transmission if immediate contact is made with contaminated instruments. Antibiotics are effective in the treatment of certain types of tuberculosis. MD0509 1-6 . is spread by an airborne droplet and consists of many different antigenic types. e. Influenza and the Common Cold. it cannot survive for long when exposed to air. Syphilis. c. The oral lesions vary greatly in their appearance.

diabetes. 1-11. When natural resistance is lowered. and furniture of the dental treatment facility collect dust and dirt that harbor disease-causing microorganisms. Candidiasis (Moniliasis. During dental treatment. as follows. Thrush). Thus. the dental officer and the dental specialist touch a variety of instruments and equipment. GENERAL Dental patients and dental health delivery team members are all sources and potential victims of infectious disease.f. Candidiasis is a surface infection of the mouth caused by a yeast-like fungus. INDIVIDUAL PRECAUTIONS/PROTECTION The dental specialist should be concerned with the hazard of infection and should take precautions to avoid cross infection. MD0509 1-7 . leukemia. 1-10. floors. PROCEDURES FOR PROTECTION AGAINST INFECTION 1-9. patients receiving certain antibiotics. or immune system deficiency. the basis of infection control is cleanliness. It may affect newborn infants. Universal precautions may be defined as treating all patients alike since it is impossible to always determine how potentially infectious each patient may be. such as appointment time restrictions. c. This fungus is normally present in the mouths of healthy persons. Definition. Saliva in the dental setting is considered an "other potentially infectious material" (OPIM) and must be treated the same as blood. 1-12. Equal Treatment. Section II. b. as potentially infectious. that is. this infection may appear and grow. Saliva. "high risk" protocols. Disease can be easily transmitted in the dental treatment facility. All patients are to be treated alike. as well as the patient's oral cavity. Special restrictive alternatives are not appropriate. CLEANLINESS IN THE CLINIC The walls. and adult patients debilitated caused by alcoholism. or special treatment rooms. UNIVERSAL PRECAUTIONS a. There are standard precautionary procedures routinely taken to reduce the risk of potential cross infection.

Dental care personnel must wear gloves during cleaning and disinfection procedures and during patient care. the dental officer. Surgical Masks. and Outer Garments. the most effective barrier is through frequent hand washing. Gloves must be changed between patients and not washed or disinfected. (2) The mask must be changed between patients and more often if the mask becomes visibly soiled. (1) Team members must wear disposable surgical masks to protect themselves and the patients from the transmission of respiratory infections. then protective covering must be worn. If the dental health care worker anticipates the need for extended coverage (such as long sleeves) to prevent exposure to skin or underclothes. While gloves provide a barrier to disease transmission. and the patient should have all inoculations up to date. spray. Protective Glasses. e. Smocks. (1) The dental specialist. d. generates a contaminated aerosol mist that can transmit disease. or splatter are anticipated.a. The dental specialist. in combination with the patient's saliva. (3) Protective glasses must always be worn by dental health care workers to deflect fragments of material expelled from the patient's mouth during operation of the high-speed handpiece. (1) Hospital scrubs (with long sleeve outer garment available). lab coats. b. washable cloth gowns. All military dental health care workers must receive the hepatitis vaccine. Inoculations. (2) The amount and type of coverage depends upon the dental health care workers anticipation of exposure to blood or OPIM. smocks. (2) Safety glasses (with solid side shields or with chin length face shields) or goggles must be worn by the dental health care worker (DHCW) whenever splashes. the dental officer. Gown. It must be offered to all civilian dental health care workers with patient contact. c. MD0509 1-8 . and/or disposable gowns are all acceptable for use. Military duty uniforms or civilian "street clothes" (above the waist) are not to be worn as outer garments when exposed to blood or OPIM. and the patient must wear protective glasses that protect their eyes from hazardous spray or splatter. The water spray of the high-speed handpiece. One hour is considered the maximum effective usage time of one mask. Gloves.

for 15 seconds. and around the fingernails. (7) (8) (9) Repeat steps 1 through 6 two more times. b. Use of a Mouthwash. the knuckles. (1) Steps 1 through 9 of paragraph b should be performed by the dental specialist and the dental officer at the beginning of each work day. When to Perform the Hand Washing. (1) (2) Remove all rings. (3) Dispense 3 to 5 ml of soap or antimicrobial surgical hand scrub (4 percent chlorhexidine gluconate) into the right or left cupped hand. The routine use of this technique avoids skin abrasion that makes microbial entry possible when a DHCW is contaminated through defective gloves. Putting On Gloves. Wet hands with cool to lukewarm water. (5) (6) elbow. (2) After each occurrence of removing gloves throughout the day. carefully paying attention to the wrist. the patient should be encouraged to rinse with a suitable mouthwash to provide a short-term reduction of oral bacteria. Before dental treatment. 1-13. Dry the hands with a disposable or sterile towel (one per hand). letting water run in the direction of the c. a. ASEPTIC HANDWASHING TECHNIQUE All dental health care workers are required to utilize the following aseptic technique before working on a patient. hands are to be washed with a simplified 15 to 30 second hand wash with antimicrobial soap. Use the last towel to close the faucet before disposal. Repeat steps 1 through 4 for the other hand. Glove according to the sterile gloving procedure. d. The three-hand washing technique outlined below is recommended before putting on gloves.f. Steps of Procedures for Three Hand Washings. General. (4) Wash the right or left hand. Rinse the hands with cold water. MD0509 1-9 .

Continue with Exercises MD0509 1-10 . called sterile technique. STERILE TECHNIQUE In certain oral and periodontal surgical procedures. large open wounds require a regimen of very strict attention to infection control. The dental specialist must be aware of the principles of sterile technique and of local guidelines concerning its use.1-14.

a. 2. MD0509 1-11 .EXERCISES. c. LESSON 1 INSTRUCTIONS: Answer the following exercises by marking the lettered response that best answers the exercise or best completes the incomplete statement or by writing the answer in the space provided. Streptococci refers to round-shaped bacteria arranged in: a. Bacteria. c. For each exercise answered incorrectly. Select the microorganism that requires living tissue cells rather than a laboratory culture media to support growth and reproduction. Spiral-shaped bacteria are called: a. b. Fungi. Coccus. Bacillus. After you have completed all the exercises. 1. Viruses. Spirilla or spirochete. Pairs. c. reread the material referenced with the solution. Chains. Clusters. turn to "Solutions to Exercises" at the end of the lesson and check your answers. 3. Palisades. b. b. d.

(3) ______ Hepatitis. b. Facultative streptococci. Opportunistic microorganisms. 7. Molds. d. (2) ______ Dysentery. Direct personal contact. What is the typical bacterial count for saliva from the dorsal surface of the tongue? a. Candida albicans. COLUMN I COLUMN II a. Oral spirochetes.4. Match the disease in Column I to the transmission route for infection in Column II. b. Yeasts. 6. MD0509 1-12 . Which of the following microorganisms are anaerobic and inhabit the gingival sulcus? a. c. b. 5. Through the gastrointestinal tract. Through the respiratory tract. round. Lactobacilli. b. Which of the following are usually large. 750 million per milliliter. 75 billion per milliliter. 75 million per milliliter. c. (4) ______ Bacteria causing dental caries and periodontal disease. (1) ______ Influenza viruses. or oval cells and reproduce by budding? a. d. c.

Tuberculosis. Active immunity. Candidiasis. b. 10. The skin. c. e. d. d. c. Hepatitis. e. 9. Passive immunity. MD0509 1-13 . Which of the following diseases can be transmitted by dental scalers that have come into contact with contaminated blood? a. it is known as: a.8. Dental caries. Influenza. b. The eye. Essential vitamins. are produced by: a. b. When a person manufactures antibodies in response to an antigen. The respiratory tract. The lower colon. White blood cells. mentioned in the text as a defense mechanism of the body.

Hepatitis. _____________________________________________________. Syphilis. 13. Saliva in the dental setting is considered as an " ___________ ___________ ___________ ___________ " (OPIM) and must be treated the same as ___________. Tuberculosis. c. as in the case of debilitated adult patients? a. MD0509 1-14 . List individual protective measures taken to avoid cross infection. _____________________________________________________. _____________________________________________________. _____________________________________________________. Candidiasis. d. Influenza. Which of the following infections may appear and grow when natural resistance is lowered. b. e. 12. _____________________________________________________.11. The basis of infection control in the dental treatment facility is __________. 14.

15." "b. All precautions are always necessary. All patients are treated alike (potentially infectious). e. b. Saliva is considered a body fluid. All DCHW's must take precautions before each dental appointment. "b" and "c" above. d. Cleaned using sterile gauze on the outside surface. c. Washable cloth gowns. Hospital scrubs (with long sleeve outer garment available). Only simple precautions are needed for some patients. which of the following must be worn as outer garments over underclothes? a. MD0509 1-15 . Changed between patients. Any of the above. c." and "c" above. e. Gloves must be: a. b. Smocks or lab coats. b. d. "a. d. 17. Disposable gowns. When DCHW's anticipate exposure to blood or OPIM. "Universal precautions" means: a. Worn during patient treatment. 16. c. e.

After each occurrence of removing gloves throughout the day. c. Remove all rings. Use numbers 1. 45 seconds. Dispense 3 to 5 ml. Wet hands with cool to lukewarm water. Check Your Answers on Next Page MD0509 1-16 . b. and so forth. 60 seconds. 2. 36 seconds.18. 19. of soap into the cupped hand. Rinse the hands with cold water. ____ ____ ____ ____ ____ ____ ____ Wash one hand. d. In the three-hand washing technique. the hands are to be washed with a __________ 15 to 30 second hand wash with _____________ soap. Dry the hands with a disposable towel. Write in the space provided the correct sequence for the three-hand washing technique required of all dental health care workers. Use the last towel to close the faucet. 30 seconds. how many seconds (in total) is each hand washed with antimicrobial surgical hand scrub or soap? a. then the other hand. 3. 20.

"other potentially infectious material". smocks. 13.SOLUTIONS TO EXERCISES: LESSON 1 1. 9. 6. 15. figure 1-2) (para 1-3) (para 1-5) (para 1-5) c d a b (para 1-6) 8. Protective glasses. figure 1-1) (para 1-2. 18. 3. Surgical masks. 10. blood d e d c (para 1-11c) (para 1-12e) (para 1-12d) (para 1-13b(4)) MD0509 1-17 . (para 1-7c) (para 1-7d) (para 1-8a) (para 1-8f) (para 1-10) cleanliness Inoculations. 7. Gloves. (para 1-12) (para 1-11b) 14. Gowns. 11. c b a b c d (1) (2) (3) (4) a d e c (para 1-1) (para 1-2. 5. 4. 2. 12. 17. or outer garments. 16.

simplified. antimicrobial End of Lesson 1 MD0509 1-18 .19. 4 5 6 3 2 1 7 (para 1-13b) (para 1-13d(2)) 20.

2-2. Identify procedures for preparing. 2-6. Identify packaging materials and the expected shelf life of sterilized packages. 2-8. complete the exercises at the end of this lesson. Identify chemical agents recommended and not recommended for disinfection. to include guidelines for classifying dental items. Identify disinfection procedures for fixed and semi-fixed equipment SUGGESTION After completing the assignment. Identify procedures for disposal of regulated waste. to include guidelines for cleaning the steam sterilizer. Identify guidelines for cleaning and inspecting instruments prior to sterilization.LESSON ASSIGNMENT LESSON 2 TEXT ASSIGNMENT LESSON OBJECTIVES Sterilization and Disinfection. Identify how an autoclave works. These exercises will help you to achieve the lesson objectives. Identify the difference between sterilization and disinfection. 2-11. 2-7. you should be able to: 2-1. loading. Identify various modes of heat sterilization and the use of each mode. 2-5. After completing this lesson. 2-10. MD0509 2-1 . 2-4. Identify bacteriological spore testing and how to interpret results. Identify procedures for storing and handling sterile items. and operating the steam sterilizer. Paragraph 2-1 through 2-22. 2-9. 2-3.

boiling water may be used for sterilization. Disinfection destroys or inhibits most pathogenic organisms. any instrument which may penetrate tissue or bone must be sterilized. however. potentially harmful microorganisms may remain. and pressure provide the easiest. (1) Disinfection. and equipment that has been exposed to a patient's body fluids and/or tissues. some resistant." and "sanitizer" fall into the category of disinfection. The dental specialist should have a clear understanding of this classification to ensure proper handling. temperature. b. This is achieved through the correct utilization of sterilization methods. CLASSIFICATION OF DENTAL ITEMS a. Even though most infectious material is destroyed by disinfection. STERILIZATION. Overview. b. such as scalpel blades and injection needles." "germicide. and most common means of sterilization in the dental clinic. Chemical disinfectants provide the most efficient means of disinfection. (2) Sterilization. Generally speaking. 2-2. and viruses found on instruments. Surface disinfectants are applied to operatory surfaces and equipment that cannot be removed and immersed and heated. Sterilization destroys all forms of life within an environment. NOTE: As a field expedient method. Critical Disposable Items. materials. Proper cleaning of items to be sterilized and disinfected is necessary to prevent cross-infection. Steam.LESSON 2 STERILIZATION AND DISINFECTION Section I. Definition of Terms. Sterilization procedures are applied in dentistry to reduce the possibility of cross contamination by killing all bacteria. bacterial spores. STORAGE. General. boiling water requires 30 minutes to kill all spore-forming microorganisms. Such terms as "antiseptic. are introduced beneath the oral mucosa and carry the greatest risk of infection. but that have been touched by patients or dental staff or have been exposed to aerosol or splatter produced by high speed dental equipment such as handpieces. chemical vapor. Critical disposable items. Dental items are classified according to the need and practicality for achieving disinfection or sterility. These items require sterility before use and special procedures for disposal after use. General a. MD0509 2-2 . AND DISPOSAL 2-1. quickest. or dry heat under specific conditions of time.

This method of sterilization should be used in preference to room temperature chemical means. but steam will rust endodontic instruments or burs. that do not come in direct contact with the patient are wrapped with plastic wrap or aluminum foil and changed after each patient. The autoclave (pressure steam sterilizer) sterilizes using steam (moist heat) from distilled water. HEAT STERILIZATION Heat is the most practical and dependable method of achieving sterility. Noncritical items. 2-4. d. such as scissors and pliers. All packs must be loosely arranged in the trays to ensure penetration by the steam to the center of the pack. Glass bead heat transfer is used at chairside to sterilize the files and the small instruments used in endodontic treatment. such as surgical instruments. General. Critical Nondisposable Items. See figure 2-1. Burs and endodontic instruments are sterilized using dry heat or chemical vapor under pressure. Items touched by hands during treatment require careful attention and disinfection before treating each new patient. STERILIZATION BY THE AUTOCLAVE (MOIST HEAT) a.c. All hinged instruments. plastic instruments. Noncritical Items. and hard rubber or nylon products can be sterilized in an autoclave. Instruments of stainless steel or carbon steel. such as lamp handles and cabinet tops. 2-3. METHODS Autoclave Chemical Vapor Dry Heat TEMPERATURE 121ºC (250ºF) 132ºC (270ºF) 132ºC (270ºF) 160ºC (320ºF) 171ºC (340ºF) TIME 30 minutes 7 minutes 20 minutes 2 hours 1 hour PRESSURE 15 psi 30 psi 20 psi NONE DISADVANTAGES Rusts and/or corrodes instruments Formaldehyde fumes Increased time for penetration Figure 2-1. Dry heat is effective for sterilization but usually takes longer. but only for one patient at a time and not for use on other patients. Critical nondisposable items. Comparison of various modes of heat sterilization. should be placed with the joints open. Another example is an endodontic file. MD0509 2-3 . are able to penetrate tissue or bone and must be sterilized.

removing the strainer and wiping it to remove sediment deposits. and the power cord and the chamber door gasket visually checked. The unit uses high frequency sound waves to create cavitation. [Since water boils at 212ºF (100ºC) the required temperature can only be attained by raising the pressure. The solution is then poured into the reservoir and the chamber is allowed to fill until the solution covers the deposits. 250ºF creates a pressure that. at sea level. Cleaning by Cavitation. as needed. and replacing the strainer. As steam condenses on a cool instrument in the autoclave. rinsing the interior surfaces thoroughly with fresh water. plastic. draining the water from the chamber. The ultrasonic cleaning unit does not sterilize an item. The actual sterilization time of 30 minutes allows ample time for the steam to enter the packaging material. which may be paper. Thus. it only cleans the item. 2-5. the door hinges should be lightly oiled. Steam has a very high heat of condensation. wiping the surfaces dry to avoid water marks. After that. All items must be exposed to enough steam under pressure to destroy all microorganisms. Cleaning the Steam Sterilizer (Autoclave).b. (2) Removing visible mineral deposits. is equal to 15 pounds per square inch. The ultrasonic cleaning unit is used in preparing and cleaning instruments for sterilization. they are wiped away. Cavitation is a process of continuous formation and implosion of microscopic bubbles in a cleaning solution. When the deposits loosen. it releases a large amount of heat energy that destroys microorganisms by denaturation of proteins and results in sterilization. This creates a gentle scrubbing action that penetrates all exposed surfaces. THE ULTRASONIC CLEANING UNIT a. Routine maintenance includes cleaning the exterior surfaces with the mildest of cleaning solutions.] Temperature is thermostatically controlled on autoclaves. The autoclave is heated to 250ºF (121ºC) and set at a pressure of 15 pounds per square inch for 30 minutes. To remove visible mineral deposits. (1) Routine maintenance. a cleaning solution recommended by the manufacturer's instructions is to be used. or muslin cloth. MD0509 2-4 . Rinsing and drying still must be done before sterilization. washing the chamber and trays with a mild detergent solution and cloth. c. rinsing the detergent residue away from the chamber and trays with fresh water and wiping dry with a lint-free cloth. The water is drained from the chamber and reservoir. In addition. The dental instrument sterilizer must be cleaned so that all residue and mineral deposits are removed. Standard Process. the cleaning solution is drained from the chamber and reservoir and the chemical residue is removed by flushing with distilled water and wiping dry. and that is why steam can cause so much damage to organic matter. leaving them free of all foreign matter.

If dull. debris. or other defects. It is recommended that local policy be followed regarding lubrication. (1) pieces. Only ultrasonic cleaner solutions are effective in an ultrasonic unit. holes. other solutions may not be substituted. if necessary. Before packaging instruments for sterilization. Prior to using the ultrasonic cleaner unit if visible debris is present. stains. Inspect instruments for sharpness and for proper closure.b. b. sharpen the instrument. Metal items. (3) Linens. The holding solution should be prepared first thing in the morning and replaced with fresh solution after the morning patient session. (3) (4) 2-7. and usable several times. Characteristics. 2-6. General. If they are soiled. Four Steps. tested for function. four steps must be taken. and bent or missing MD0509 2-5 . Normally. repairing. Remember that all hinged instruments remain open during the cleansing procedure. b. saliva. cracks. PREPARING INSTRUMENTS FOR STERILIZATION a. blood. Pat the instruments dry to remove excess water. (2) Clean the instruments ultrasonically. This prevents splashing and possible injuries to the operator. and sorted. and replacement and for disposal of unserviceable items. Items are to be placed in the ultrasonic cleaner rather than dropped. the process of preparation must be repeated. Cleaning solutions available for the ultrasonic cleaner are harmless. sharpening. Oil the instrument. Inspection Factors. INSPECTING ITEMS FOR STERILIZATION a. (1) Soak instruments in a holding solution prior to using the ultrasonic cleaner unit. All items must be inspected after they have been cleaned. chemically stable. (2) Hinged instruments. an article should remain in the cleaner for 10 to 15 minutes. and tissue. General. Inspect for signs of rust. Open all hinged instruments during cleaning and sterilization. Inspect linens for tears. dried. Rinse the instruments under warm running water. scrub the instruments under warm running water to remove all scale. chips.

Dental instruments are packaged individually in sets or in packs. (2) Plastic or nylon. nylon. label the packages with a shelf-life expiration date.2-8. and cloth. plastic. and wovens Nonwovens. or plastic and paper laminate when heat sealed SHELF LIFE 72 hours 6 months Cloth. When cloth is used as a packaging material. When packs are opened. they should be opened using an aseptic technique. It only serves as an indicator that the critical temperature was reached. the pack (after sealing) should be 20 percent longer than the longest instrument. It is not an indicator of sterility. (1) Paper. depending upon the intended use. 2-9. The most common materials are paper. PACKAGING INSTRUMENTS FOR STERILIZATION a. The size of the individual pack will generally determine the best packaging material. use a double Figure 2-2. (3) thickness. Labeling Packages with a Shelf Life Expiration Date. HEAT-SENSITIVE ADHESIVE TAPE TEST Heat sensitive indicator tape [chemical indicator (CI) tape] serves as a binder to seal wrappings or packs. its length should be 2 1/2 times longer than the width of the tubing or the paper envelope. Expected shelf life of instruments wrapped in different materials. b. The extra length allows inside air to expand and ensures that a single heat seal will hold. muslin. WRAPPER Autoclave paper bags. The tape has been treated so that portions of its surface change color when subjected to certain temperatures. When the sterilization and disinfection cycles are complete. This date should correspond to the shelf life listed in figure 2-2. When tape is used for sealing. MD0509 2-6 . Instruments can be packaged in paper envelopes. nylon. The extra length of the package allows inside air to expand. It is important to make sure that scissors. The packages must be stored in a clean area. plastic. General. When plastic or nylon sterilization tubing is used to package instruments. This allows the tape to be sealed upon itself after the tube or paper envelope is folded. hemostats. but does not prove that the necessary time was maintained for sterility. All packages should be wrapped loosely to allow the sterilizing agent to circulate freely throughout the pack. and other hinged instruments are in the open position.

Spores are used to set the standard for testing the efficiency of sterilizers because spores are the most difficult form of bacteria to destroy. BACTERIOLOGICAL SPORE TESTING a. A spore strip or vial that tests positive after running in a sterilizer for the full cycle indicates bacteriological growth and is evidence that the sterilizer did not kill the spores. call the medical maintenance office for repair of the sterilizer. Suspend use of the sterilizer. d. MD0509 2-7 . FUNCTIONAL TESTING OF THE STERILIZER Routine testing of the sterilizer is necessary to ensure proper functioning. Check the expiration date of the test batch. One uses spore strips and the other uses spore vials.2-10. It should also be positive. The tests must be performed weekly and the results must be kept on file for one year. The manufacturer's instructions must be followed for each of the spore test brands. Other dental facilities have a self-contained incubator for testing spore vials. and increased risk of false positives. Sterilizers must be tested with bacteriological spore tests at least once a week. (1) (2) (3) Check the control strip or vial. Interpreting Spore Testing Results. General. (6) If the second test is positive (including the control). Some dental facilities send bacteriological spore strips from the sterilizers to a microbiology laboratory for culture tests. Two Types of Testing. Each type uses the concept of a control strip or control vial that is activated but not sterilized in order to prove that the test batch is still usable. Procedure for Testing. b. (2) Facility incubator. (1) Outside medical laboratory. There are two systems used for bacteriological spore testing. c. The results warrant the following actions. The vial system is more popular because it eliminates the necessity of an outside laboratory with their transportation costs. 2-11. (4) Recall and resterilize (in a different sterilizer) all items sterilized after the last negative laboratory test (one week before) using the load control number (LCN). (5) Perform the spore test again. communication problems.

spore vials) are inserted in the center of the thickest packages to be sterilized. The cleaning and disinfecting must be documented using a log. The manufacturer's instructions should be strictly followed when storing commercially prepared presterilized items. The water must be level with the indicator mark and the process is verified visually. Then. Packages are arranged loosely to allow steam to circulate between packages. Then. Proper sterilization and disinfection techniques are of little value unless proper attention is directed to the safe storage of sterile items. the sterilization monitors (e. Preparing the Sterilizer for Use. the sterilizer power cord is plugged into a power source. Be careful to stand to the side when opening the door because of steam release and be careful not to touch the metal part of the sterilizer. Cabinets used to store sterile packs must be cleaned and disinfected monthly.) When the chamber is properly filled. Sterile packs should be visually inspected prior to use. When testing of the sterilizer is done. assume that the first test was accidentally contaminated during culturing. (Note that the heating element is located in the chamber of the autoclave. The timer is set for 15 minutes. STERILIZING DENTAL ITEMS a. The sterilizer is functioning properly and may be placed back in operation. First. The packages are placed on their sides to prevent cross-contamination of the instruments. Safe Storage. The packages are placed on the trays. The thickest. When the trays are loaded. STORAGE AND SHELF LIFE OF STERILE ITEMS a. The reservoir cover is put back on. The packages are never stacked one on the other. the load information is logged into the sterilizer logbook. MD0509 2-8 . The sterilizer is preheated by turning the power control knob to STERILIZE. As soon as the temperature is at the required temperature (250ºF) and pressure (15 psi). The autoclave must be level so that the heating element is covered with water. the chamber door is opened. When it has finished.(7) If the second test is negative (and if the control is positive). the autoclave is vented (if required). and the contents are allowed to dry. Next. Loading the Sterilizer Trays. most dense packages are placed in the bottom tray. Nonporous items and thinner items are placed in the topmost tray. c. 2-13. b. the sterilization cycle can begin. the chamber is filled with water from the reservoir by rotating the power switch to FILL. the trays are placed in the autoclave chamber. the water reservoir is filled with distilled water until the water level reaches the FULL indicator. the power switch is turned to OFF. The timer is reset for 30 minutes and the sterilizer is allowed to complete the cycle. Operating the Sterilizer.g. 2-12. The sterilizer door is closed and secured. Packs stored beyond their expiration date or suspected of being contaminated must be rewrapped and sterilized.

the contents of the load. 2-14. and the amount of handling. MD0509 2-9 . b. The sixth and seventh digits designate the number of times a sterilizer is used in a 24-hour period. The first two digits designate the assigned number of each sterilizer. fourth. Inventory Control. If packages are found with expired dates. the signature of the operator (written at the time of load). (1) Mask and sterile gloves. Sterilized items have a shelf life determined by the type of wrapping used (See figure 2-2). the expiration date. The Sterilizer Logbook. this system enables personnel to establish control over instruments "sterilized" in a malfunctioning sterilizer. The day on which items are sterilized is considered the first day of the shelf life if they are stored in a dust-free area. Load Control Number (LCN). The third. and fifth digits designate the Julian calendar day (For example. If the spore test is positive on a particular sterilizer. the day on which items are sterilized is considered the first day of the shelf life if they are stored in a dust-free area. Surgery and certain specialized procedures require the use of sterile gloves and mask. All sterilized items must be labeled with the LCN and the expiration date. All instruments from the sterilization or disinfection cycle must be handled with mask and sterile gloves. For inventory control. the LCN. d. and the LCN tells which sterilizer was used. Guidelines. Standard guidelines follow. to include the sterilizer number.b. the packages must be repackaged and resterilized. the date. 365 is December 31st [assuming it is not a leap year] and 006 is January 6th). A clinic may have five or six sterilizers. The proper handling of sterile items will prevent injury and cross infection. the conditions during transport. Sterilized items have a shelf life determined by the type of wrapping used (see figure 2-2). e. Shelf Life. All sterilized items must be labeled with the LCN and the expiration date. HANDLING PROCEDURES FOR STERILE ITEMS a. It is required also that all packages be marked visibly with an expiration date using the day/month/year format. and the results of spore testing. The dental specialist should follow recommended guidelines when using sterile items. The dental specialist must enter the load information. A sterilizer logbook must be maintained. the storage conditions. the LCN will enable the user to recall only those items that are identified by the first two digits. The LCN consists of seven digits. c. Thus. General.

Such an injury should receive prompt medical evaluation because one cannot always know if the patient's medical history includes an infectious disease. The dental officer may use a recapping device to replace the cover himself. suture needles. (5) Disposable items. The dental specialist should become familiar with local procedures concerning the disposal of contaminated materials." "septic. Containers. or he may slide the needle into the cap that has been placed on the bracket table using a one-hand technique. and other such items when possible to minimize cross-infection and to reduce the sterilization workload. Discard disposable needles. (6) Designated "sharps" receptacle. used needles/syringes should never be passed between the dental officer and the assistant. impenetrable plastic bags or containers colored red in which sharp items cannot break through. Regulations. Uncovered. Dispose of regulated waste according to local procedures. (1) Sharp waste. 2-15. Dispose of used needles after each appointment in the sharps container." MD0509 2-10 . Discard those that are partially used. The OSHA term "regulated waste" (RW) is used for what was formerly referred to as "infectious. (3) Individual dosage. Definitions. Use only sterilized syringes and commercially presterilized disposable needles for injections. are placed in rigid. mouth props. such as needles or blades. Each state has its own regulations concerning the handling and treatment of contaminated and regulated wastes. The container is labeled with words such as "Sharps. Regulated waste is defined by the Occupational Safety and Health Administration (OSHA) as items that can release a drop of blood or OPIM when compressed or items that are so heavily caked with dried blood or OPIM that the waste may flake off. Use individual-dose anesthetic cartridges. Use disposable saliva ejector/aspirator tips. OSHA or local/state regulations apply.(2) Disposal of needles and needle injury. Sharp disposable items. b. c. Any injury suffered by the dental specialist or dental officer from a contaminated needle or instrument has the potential of introducing serious disease (see Lesson 1)." or "medical" waste. and scalpel blades into the same designated sharp item ("sharps") receptacle. such as hepatitis. DISPOSAL OF WASTES a. (4) Recapping needles. Place all used cartridges in the sharps container. Each Dental Activity has a postexposure protocol in the standing operating procedures (SOP) that describes what steps are to be taken after such an injury or exposure. whichever is more stringent.

Disinfection is impossible to verify. Anything that can be sterilized should be sterilized. Other disposable items (such as saliva ejectors. immersion "cold sterilization" with chemicals was widely used in dentistry. rubber dams. but chemical disinfection is a practical alternative. There is no perfect or ideal disinfectant at this time. WATER LINES Organisms growing in the dental unit water lines can be a source of cross contamination between patients. therefore. flush water through the drinking water dispenser. In addition. 2-17. splatter. STERILIZATION AND DISINFECTION OF DENTAL TREATMENT ROOM EQUIPMENT The design. Today. The dental specialist should have a clear understanding of effective agents and techniques used to disinfect items that cannot be heat sterilized. flush the water lines for at least 15 seconds between patients. Room temperature chemical agents can be used to disinfect certain items when sterilization is not recommended (such as with safety glasses). size. In isolated operatories. one per operatory is required.(2) Other waste. Placement of Containers. and construction of some dental equipment complicate disinfection and sterilization. MD0509 2-11 . To reduce this possibility. and masks) may be disposed of in general waste. (3) Cautions. At one time. gloves. and contaminated gloves during patient treatment. USE OF CHEMICAL AGENTS FOR DISINFECTION Dental operatory equipment and surroundings are frequently exposed to spray. Although it would be ideal for all instruments and equipment to be sterilized. Disinfection is effective for its limited purpose. air/water syringe. 2-18. DISINFECTION 2-16. but is not a substitute for sterilization. d. In open bay clinics. mouth props. DENTACs rarely use chemical sterilants as an alternative for the preferred heat sterilization. It is impossible to sterilize these areas. Regulated waste containers with red bags or biohazard labels (meaning biological hazard) must be situated in each operatory/work area. and high-speed handpiece for 3 to 5 minutes at the beginning of each day. Section II. it is extremely important to be thorough. Containers must be closed when moved and placed in a second container if leakage is a possibility. aspirator tips. this is impossible. one per bay is sufficient.

May be used as a cleanser. immersion use only. No No Not effective. Chlorine dioxide Varies 6 hours Corrosive. the American Dental Association (ADA). irritates skin/eyes. 2. For a summary.strong odor May damage plastics. DISADVANTAGES May discolor items if mixed incorrectly. General. Not a cleanser. caustic to skin.2-19. There are several chemical agents used in the past for sterilization that are not currently recommended for use by the Center for Disease Control (CDC). Chlorine 1. Note: Use gloves when handling all disinfectants. some used at full strength. Isopropyl 2. CHEMICAL CLASSIFICATION Iodophors (1% iodine) DISINFECTANT 1:213 dilution 10 minutes 20ºC (68ºF) Some must be diluted. Sodium hyperchlorite Phenols: Complex or Synthetic Alcohol 1. STERILANT No. see figure 2-3. Figure 2-3. Army TB MED 266. CHEMICAL AGENTS NOT RECOMMENDED FOR STERILIZATION a. or U. MD0509 2-12 . Glutaraldehydes No. Not for dental use. corrosive to instruments.strong odor Corrosive.S. Reuse if possible. Chemical agents. Ethyl Quaternary Ammonium Compounds 1:10 dilution No Varies No No No No No To be used as cleanser only.

sodium hypochlorite is too corrosive to be practical. corrode rubber and plastic. but may discolor some surfaces. eyes. The chemical agents described below are recommended for use as chemical disinfectants. Iodine compounds usually combine iodine (1 percent) with a surface-active agent (detergent). Alcohols currently have no practical use in dentistry except as cleansers. d. rare instances of local sensitivity (allergy) may occur. and do not inactivate hepatitis viruses or gram-negative microbes. Quaternary ammonium compounds are inactivated by organic matter. and diminish in effectiveness when exposed to saliva and blood.) Sterility (unmonitored) is attained after immersion in full strength glutaraldehyde for 10 hours. Several types of glutaraldehyde solutions are available for use in the dental clinic and each must be mixed according to manufacturer's instructions. Chlorine Compounds. objects being disinfected should be rinsed with 80 to 90 percent alcohol or sterile water before use. Phenols. d.5 to 5 percent of chlorine that can be used to disinfect plastic items. 2-20. (1) Sodium hypochlorite. Glutaraldehyde solution is particularly useful for the chemical disinfection of rubber and plastic items or items with adhesive bonded parts. CHEMICAL AGENTS COMMONLY USED FOR DISINFECTION a. c. They are widely used for surface disinfection. such as certain mirrors that cannot be heated. Neither ethyl alcohol nor isopropyl alcohol is sporicidal. however. Currently. General. Alcohols. Quaternary Ammonium Compounds. see figure 2-3. Simple phenols are not effective for disinfection because they are not bactericidal or sporicidal. When glutaraldehyde is used for disinfection. While it can be used for sterilizing or disinfection. It is corrosive to instruments and can harm skin. Chlorine solutions must be replaced on a daily basis. Sodium hypochlorite solution is a disinfectant with a concentration of 0. They are less corrosive than most disinfectants.b. the item being disinfected is immersed in the solution. and clothing. (Others that kill spores are too corrosive. Dilution and contact time are critical. Iodophors. For a summary of the information presented below. MD0509 2-13 . They evaporate too quickly for 10-minute coverage. Since the solution is irritating to the skin. are not sporicidal or tuberculocidal. c. none are accepted for dental use. b. Glutaraldehyde should not be used as a surface disinfectant because of the toxic effects of the fumes. Glutaraldehyde. Glutaraldehyde is the only chemical that kills spores and can be used for chemical sterilizing from a practical viewpoint. Iodophors are not caustic to body tissues. The solutions are active only for a limited time and storage temperature must be controlled at 80ºF (26ºC) or below.

(2) Three-way syringe tips and aspirator tips. This equipment should be disinfected IAW local SOP or barrier protected with plastic wrap or aluminum foil. Complex or synthetic phenols contain more than one phenolic agent. Chlorine dioxide is effective for surface disinfection and is commonly used. Guidelines for Both Fixed and Semi-fixed Equipment. b. have a pleasant odor. Fixed Equipment. Disinfection must be accomplished between patients and at the beginning and end of each day. Recent improvements in regard to odor and corrosiveness may make it even more popular and useful in the future. Scrubbing under running water is necessary only if visible debris is present after use of the ultrasonic cleanser unit. Aspirator tips must be sterilized or be disposable. Room temperature chemical disinfectants will not penetrate organic matter (which may contain disease organisms) that is retained on instruments and equipment. Surfaces must be cleaned and wiped before being sprayed with the chemical disinfectant.(2) Chlorine dioxide. The advantages are that they have a clear color. 2-21. (b) Handpieces must receive pre-sterilization and post-sterilization maintenance according to the manufacturer's instructions. These coverings need to be removed and replaced after each patient. Semi-fixed Equipment. c. e. Surfaces that may be contaminated by blood or saliva and are difficult or impossible to disinfect should be wrapped with aluminum foil or plastic wrap. CLEANING PERFORMED PRIOR TO CHEMICAL DISINFECTION Both surfaces and instruments must be cleaned prior to disinfection. Disinfectants are affected by saliva and blood. (a) Handpieces must be sterilized. 2-22. The dental specialist should wipe down (clean) all dental equipment prior to disinfection. rinsed. and are less corrosive on metal. and dried prior to immersion in a chemical disinfectant. See figure 2-4. FIXED AND SEMI-FIXED EQUIPMENT a. Instruments and equipment should be placed in an ultrasonic cleanser unit. (1) Handpieces. MD0509 2-14 . Saliva and debris can be retracted into the three-way syringe tips and possibly contaminate other patients unless the tips are removed and sterilized after each patient. These phenolic agents act synergistically for their antimicrobial action. See figure 2-4. Complex or Synthetic Phenols. The disadvantages are that they can degrade certain plastics and that the fumes irritate skin and eyes.

Figure 2-4. Continue with Exercises MD0509 2-15 . Disinfection of fixed and semi-fixed items.

turn to "Solutions to Exercises" at the end of the lesson and check your answers. For the following list of dental items. For each exercise answered incorrectly. and equipment in water for ___________ minutes. Sterilization. Injection needles. c. place in the space provided the proper classification. Scalpel blades. a. by completing the incomplete statement. b. 2. CD = critical disposable item CN = critical nondisposable item N = noncritical item ____ ____ ____ ____ ____ ____ a. 3.EXERCISES. d. __________ destroys or inhibits most pathogenic organisms. The field expedient method used for sterilization is ___________ instruments. or by writing the answer in the space provided at the end of the exercise. b. e. f. Dental forceps. LESSON 2 INSTRUCTIONS: Answer the following exercises by marking the lettered response that best answers the exercise. Rubber dam clamps. MD0509 2-16 . materials. 1. as indicated below. After you have completed all the exercises. Lamp handles. Disinfection. reread the material referenced with the solution. Cabinet tops.

4. 6. 7. Chemical vapor. Dry heat. Chemical vapor. Which method of heat sterilization is more likely to cause rust and corrosion of instruments? a. b. Which method of heat sterilization takes longer? a. Chemical vapor. e. Autoclave. b. b. c. c. c. Match the temperature and time requirement in Column I to the method of heat sterilization in Column II. b. d. 2-17 MD0509 . COLUMN I Temperature Time COLUMN II Method of heat sterilization a. Autoclave (slower time) Autoclave (faster time) Chemical vapor Dry heat (slower time) Dry heat (faster time) (1) ____ (2) ____ (3) ____ (4) ____ (5) ____ 320ºF 2hours 340ºF 1hours 250ºF 30 min/15 psi 270ºF 20 min/20 psi 270ºF 7 min/30 psi 5. Dry heat. Autoclave. Which method of heat sterilization requires a temperature of 270ºF maintained for 7 minutes at 30 psi? a. Dry heat. Autoclave. c.

all hinged instruments must be: a. an article should remain in the cleaner _______ to ______ minutes. d. 10. During cleaning and sterilization. All packs must be ___________ arranged. 11. __________ the instruments in a holding solution prior to using the ultrasonic cleaner unit. Open. c. Complete statements related to the ultrasonic cleaning unit. Scrubbed. Complete statements related to sterilization by the autoclave. __________ is a process of continuous formation and implosion of microscopic bubbles in a cleaning solution. Complete information related to preparing instruments for sterilization. Wet. b. d. a. Endodontic instruments and burs will __________ when exposed to steam. Normally. c. a. The ultrasonic cleaning unit only cleans an item. __________ the instruments under hot running water. c. The autoclave sterilizes using steam from __________. MD0509 2-18 . __________ the instruments __________. __________ the instruments ultrasonically.8. Closed. b. b. b. 9. c. It does not __________ an item. a.

"a" and "d. 30 days. muslin. b. Cracks and chips. d. e. Proper closure. 5 days. b. Nonwoven materials. nylon. 14. Six months is the expected shelf life of dental instruments wrapped in: a.12. plastic. and woven materials. 7 days. Hinged instruments are inspected before sterilization for: a. b. e. "b" and "c. MD0509 2-19 . c." 13. d." f. 6 months. Autoclave paper bags. c. What is the shelf life of (sterilized) packaged instruments wrapped in double thickness muslin? a. Stains. Sharpness. 3 days. or plastic and paper laminate when heat sealed.

50 percent. a. b.15. MD0509 2-20 . c. c. 50 percent. a. 2 1/2 times. 12 months. 18. 1 l/2 times. b. Weekly. 67 percent. Bacteriological spore testing of the sterilizer is required to be done: a. the pack (after sealing) should be __________ longer than the longest instrument. c. 20 percent. the tape used for sealing should be __________ longer than the width of the paper envelope. When plastic or nylon sterilization tubing is used to package instruments. 18 months. c. Monthly. 100 percent. b. 17. When instruments are packaged in paper envelopes. d. Twice a week. 16. d. b. 6 months. The test results of routine testing of the sterilizer must be kept on file for: a. 33 percent.

c. Second test positive. control positive. Use of sterilizer suspended. items recalled. Where are spore strips sent for culture tests? a. In-house laboratory. MD0509 2-21 . b. Spore vials. b. Spore strips. When are you required to call the medical maintenance office for repair of the sterilizer? a. d. A self-contained incubator at a dental facility is used to test: a. 22. Expiration date of the test batch has passed. The necessary time was maintained for sterility. control negative. 21. 20. Outside laboratory. The critical temperature was reached.19. When heat-sensitive adhesive tape on a pack in a sterilizer changes color. Second test positive. b. b. this indicates that: a.

2. Follow manufacturer's instructions. COLUMN I: Storage Item (1) ____ (2) ____ Sterile packs. The LCN is 0204503. Match the storage item in Column I to the action recommended in Column II. All instruments from the sterilization or disinfection cycle must be handled with (more than one response may be chosen): a. Commercially prepared presterilized items. 24. What is the assigned number of the sterilizer and how many times has it been used that day? a. b. Heat-sensitive adhesive tape. COLUMN II: Recommended Action a. Rubber household gloves. No. Inspect visually. b. a. Used 3 times.23. Complete statements related to storage of sterile items. Packs stored beyond their expiration date. 3. 26. Sterilized items must be stored in a __________ area. Used 2 times. All sterilized items must be labeled with both the __________ and the __________. Sterile gloves. b. 25. b. c. (3) ____ c. Rewrap and resterilize. No. d. A __________ of sterilized items must be maintained. MD0509 2-22 . c. Mask.

At the beginning of each working day. the containers must be closed when moved and placed in a ___________ container. Used uncovered needles/syringes can be passed back and forth between the dental officer and the assistant. No. Complete information related to the disposal of wastes. 29. b. False. Regulated waste containers with __________ bags or labels must be situated in each operatory/work area. True. Are disposable saliva ejector/aspirator tips and disposable needles or suture needle and scalpel blades discarded into the same receptacle? a. 30. Yes. Flush the water lines for at least __________ seconds between patients. and high-speed handpiece for __________ minutes. 28. a. b. If __________ is a possibility. b. b. MD0509 2-23 . Complete statements related to guidance concerning possible cross-contamination in water lines. Regulated waste is defined by OSHA (in part) as items that can release a drop of __________ or ___________ when compressed. a.27. the dental specialist should flush water through the drinking water dispenser. c. a. air/water syringe.

________________________________________. b. b. No. No. ________________________________________. List four chemical agents commonly used for disinfection. ________________________________________. List two chemical agents not currently recommended for disinfection. b. d. a. ________________________________________. and dried prior to sterilization? a. rinsed. 34. ________________________________________. c. Should surfaces be cleaned and wiped before being sprayed with a chemical disinfectant? a.31. 33. MD0509 2-24 . a. 32. b. Should instruments and equipment be placed in an ultrasonic cleanser unit. ________________________________________. Yes. Yes.

e. 37.35. 5 percent. b. Complex or synthetic phenols. 36. d. b. Which chemical disinfectant can be used for sterilizing if the item is immersed for a minimum of 10 hours? a. c. c. Glutaraldehyde. 1 percent. b. Quaternary ammonium compounds. 10 percent. Iodophors. What percentage of iodine is combined with a surface-active agent (detergent) to form the iodophor? a. c. d. MD0509 2-25 . Complex or synthetic phenols. a. Glutaraldehyde. Iodophors. 20 percent. Chlorine dioxide. Select the chemical agent that must not be stored where the temperature may rise above 80ºF and that is not used as a surface disinfectant because of the toxic effects of the fumes. d. Chlorine.

e. e. c. c. e. d. Chlorine dioxide. Glutaraldehyde. 40. Iodophors. d. b. Sodium hypochlorite. Quaternary ammonium compounds. 4:1. 1:20. b. 39. MD0509 2-26 . Sodium hypochlorite.38. Which of the following is/are commonly used for surface disinfection? (More than one response may be correct. c. d. 1:10. Iodophors.) a. Isopropyl alcohol. 1:32. 1:213. Isopropyl alcohol. b. Glutaraldehyde. What is the dilution ratio for sodium hypochlorite? a. Which of the following chemical agents is neither sporicidal nor tuberculocidal and are not accepted for dental use/ a.


According to the text, which chemical disinfectant must be replaced on a daily basis? a. Iodophors. b. Glutaraldehydes. c. Chlorine.

d. Phenols.


Of the following chemical disinfectants, which one is NOT caustic to body tissues? a. Phenols. b. Iodophors. c. Glutaraldehydes.

d. Chlorine.


Of the chemical agents commonly used for disinfection, which one has a clear color, has a pleasant odor, and is less corrosive on metal? a. Iodophors. b. Glutaraldehyde. c. Alcohols.

d. Chlorine dioxide. e. Complex or synthetic phenols.




Select the disposable items that must be changed after each patient. (More than one response may correct.) a. Three-way syringe tips. b. Saliva ejector coupling. c. Head rest covers.

d. Bracket tray liners. e. HVE handle.


Which of the following should NOT be sterilized in an autoclave? a. Endodontic instruments. b. Carbon steel instruments. c. Hard rubber or nylon products.

d. Stainless steel instruments.


Which of the following are sterilized using dry heat or chemical vapor under pressure? (More than one response may be correct.) a. Stainless steel instruments. b. Carbon steel instruments. c. Endodontic instruments.

d. Plastic instruments. e. Burs.


Surfaces that are difficult to disinfect should be wrapped with __________ wrap or __________ foil.




Disinfection must be accomplished: a. At the __________ and __________ of each day. b. __________ patients.

Check Your Answers on Next Page



dry 9. 13.SOLUTIONS TO EXERCISES. (para 2-6b) 11. b (para 2-1a) (para 2-1b(2) Note) boiling. para 2-8a(3)) MD0509 2-30 . 12. (figure 2-1) 5. 15 (para 2-5) Soak Clean Rinse Pat. 2. (para 2-7b(2)) (para 2-7b(2)) (figure 2-2. (figure 2-1) (figure 2-1) (figure 2-1) distilled water loosely rust (para 2-4a) Cavitation sterilize 10. 6. 30 a b c d e f (1) (2) (3) (4) (5) c a b a b c a b c a b c d c e e N CD CN CD N CN d e a c b (para 2-2) 4. 3. 10. 8. LESSON 2 1. 7.

14. 15. 16. 17. 18. 19. 20. 21. 22. 23.

a a d b b a b a c

(figure 2-2) (para 2-8a(1)) (para 2-8a(2)) (paras 2-11c; 2-9) (para 2-11c) (para 2-9) (para 2-11b(1)) (para 2-11b(2)) (para 2-11d(6))

(1) c (2) a (3) b b a b c b, c b b a b c a b

(para 2-13a)

24. 25.

(2-13b) logbook dust-free LCN; expiration date (para 2-14b(1)) (para 2-14b(4)) (paras 2-14b(6); 2-15c(1),(2) blood; OPIM red; biohazard leakage; second 3-5 15 (para 2-17)

(para 2-13c,d)

26. 27. 28. 29.

(para 2-15a,d,c(3))



Alcohols Quaternary ammonium compounds

(para 2-19)




Iodophors Glutaraldehyde Chlorine compounds Complex or synthetic phenols a a d a c (para 2-21) (para 2-21) (para 2-20c) (para 2-20b; figure 2-3) (para 2-20c)

(para 2-20)

33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48.

d, e (para 2-20b,d) d a c b e c, d a c, e (para 2-19c) (Figure 2-3) (para 2-20d) (para 2-20b) (para 2-20e) (figure 2-4) (para 2-4a) (para 2-3) (para 2-22c)

plastic; aluminum a b

beginning; end Between (para 2-22c)

End of Lesson 2




Drugs in the Dental Clinic Paragraph 3-1 through 3-32. After completing this lesson, you should be able to: 3-1. Identify basic terminology related to drugs and to drug usage. Identify purposes and uses of local anesthetics. Identify purposes and uses of analgesics. Identify purposes and uses of antibiotics. Identify purposes and uses of hypnotics and sedatives. Identify purposes and uses of topical antiseptics. Identify purposes and uses of hemostatics. Identify the classification of specific drugs. Identify dental specialist responsibility in relation to emergency kits and emergency aid.

3-2. 3-3. 3-4. 3-5.


3-7. 3-8. 3-9.

3-10. Identify administrative procedures required for prescription writing. SUGGESTION After completing the assignment, complete the exercises at the end of this lesson. These exercises will help you to achieve the lesson objectives.



or prevent disease. Orally administered medications are usually easy to take and are usually less expensive than other dosage forms. b. such as pyribenzamine for the treatment of hay fever. 3-3. (2) (3) Toxic dose. may experience drowsiness. Lethal dose. CLASSIFICATION OF DENTAL ITEMS a. A side effect is an action of a drug other than that specifically desired and is a response of an entirely different character. These medications must pass through the stomach and be absorbed in the intestinal tract. They are given to patients to diagnose. The majority of patients who receive a drug will respond to it as expected. INTRODUCTION Drugs are chemical agents that affect living tissues. A toxic dose is an overdose that causes poisoning. treat. The following are descriptive terms concerning drug dosages: (1) Therapeutic dose. tablets. By mouth. and liquids. Drugs administered by the oral route are usually taken for their systemic effect. the dental specialist should be familiar with the various drugs used. some patients may show a lesser or greater response to a given drug dosage. ROUTES OF ADMINISTRATION OF DRUGS Drugs may be given to patients in any of the following ways: a.LESSON 3 DRUGS IN THE DENTAL CLINIC Section I. Dose is the amount of a drug that produces a specific concentration of the drug at a site. Dose. BASIC CONCEPTS 3-1. MD0509 3-2 . or the quantity to be administered at one time as a specified amount of medication. For example. 3-2. However. or mineral sources or may be prepared synthetically by chemical means. Orally. It is in a dosage range between the minimum dose and the maximum dose. plant. c. A lethal dose is the amount of a drug that causes death. Drug Response. capsules. A therapeutic dose produces the desired medical effect in the patient. Drugs may be derived directly from animal. Although the dental officer is solely responsible for prescribing drugs involved in dental therapy. Side Effects. such as pills. a patient receiving an antihistamine.

d. h. g. into the vein. e. By injection. An agent is a substance capable of producing a physical. into the area next to the target tissue. Allergy. or teeth. By breathing a gaseous substance. Insulin is normally administered subcutaneously. Infiltration. Absorption of the drug is rapid.b. 3-4. MD0509 3-3 . Intravenously (IV). Topical anesthetics are most often used to anesthetize the buccal mucosa at the site of an injection. or biological effect. into muscle. eventually contacting the nerve endings and producing a loss of pain and sensations. Agent. if the drug is in an oily liquid or in the form of a suspension. and circulatory failure after contact with an allergen. By injection.) Drugs administered in this manner are rapidly absorbed. mucosa. By placement under the tongue. The drug is injected into the fatty layer under the skin but not into muscle. PHARMACEUTICAL TERMS a. life-threatening allergic reaction characterized by low blood pressure. f. Sublingually. By injection. a solution. The injection of a drug directly into the patient's veins is the most rapid route of administration. When it contacts the nerve fibers. irregular heartbeat. Allergy is a hypersensitivity to a drug. This refers to an acute. The tablet is dissolved under the tongue or in the pouch of the cheek. Anesthetics. (It is not swallowed. Topically. Sprays for nasal congestion generally have only a local effect on the tissue in the nose. The drugs are injected deeply into muscle tissue. By injection. Inhalation. However. If the drug is in aqueous (water) solution. chemical. By application to the surface of skin. b. They may be applied as an ointment. absorption is rapid. Topical anesthetic agents penetrate through the surface layers. it can prolong the action of the drug. are inhaled and exert their effect after absorption into the circulatory system. they become insensitive to pain and other sensations. Nitroglycerine in tablet form for heart patients is probably the most frequently administered sublingual drug. under the skin. Intramuscularly (IM). The drug then diffuses and penetrates through the nerve sheath. like nitrous oxide. (1) Anaphylactic shock. Subcutaneously (Sub-Q). c. or a spray. bronchial spasms. cardiovascular collapse. It can result in one or more of the following conditions.

frequently associated with allergy to foods or drugs. the act or process of calming by using drugs such as nitrous oxide and trichloroethylene. Analgesia. or other non-gastrointestinal route of administration. Chemotherapy is the treatment of disease by chemical reagents that have a specific and toxic effect upon the germs or cells that cause the disease. Urticaria (hives) is a reaction pattern of the skin marked by transient appearance of smooth. cheeks. This refers to a spontaneous swelling of the lips. tongue. (3) Asthma. g. Pharmacology. intravenous. The patient experiences the following: disassociation of environment. This term refers to the study of the uses of drugs in the treatment of disease. particularly the relief of pain without the loss of consciousness. eyelids.(2) Angioneurotic edema. d. f. (4) Syncope. An antidote is a remedy that counteracts a poison. h. (5) Urticaria. Idiosyncrasy is an abnormal response to a normal drug dose. reduction of pain. by subcutaneous. intramuscular. pharynx. slightly elevated patches that are either more red or pale than surrounding skin accompanied by severe itching. Idiosyncrasy. Antidote. Cartridge. e. This refers to a transient loss of consciousness caused by decreased blood supply to the brain (cerebral ischemia). Chemotherapy. MD0509 3-4 . c. This refers to difficulty in breathing caused by spasmodic contraction of the bronchi. Parenteral. Another word for cartridge is carpule. Analgesia is the absence of sensitivity to pain. Pharmacotherapeutics. k. soft palate. for example. and dulling of memory of the treatment experience. A cartridge is an enclosed glass cylinder containing a local anesthetic solution. Parenteral refers to the administration of a drug by injection. The patient remains conscious and retains protective reflexes. and glottis. Pharmacology is the science that deals with the study of the action of drugs on living systems. j. Sedation is the production of a sedative effect. i. Sedation.

General anesthesia is used to perform certain oral surgical procedures and to treat patients who can be best managed in the hospital environment. MD0509 3-5 . and prevention of dental diseases. b. and precautions. and a reduction in muscular activity. Physicians' Desk Reference to Pharmaceutical Specialties and Biologicals. or Ethrane®) or as an intravenous anesthetic (such as sodium pentothal). COMMON DRUGS 3-6. Mepivacaine hydrochloride (Carbocaine®). nitrous oxide. gels. or liquids/sprays. dangers. This is accomplished by interfering with the transmission of a nerve impulse to the brain. Local Anesthetics. a loss of sensation throughout the body. treatment.8 cc cartridges. while the topical anesthetics are usually provided as ointments. ANESTHETICS a. Local anesthetics used most commonly are: (1) (2) (3) Lidocaine hydrochloride (Xylocaine®). The injectable local anesthetics are supplied in 1. They are used almost exclusively either as an inhalation anesthetic (such as ether. actions. The appendix provides a listing of drugs that are commonly used in dentistry. Section II. When local anesthetics are used during treatment. SF 603. Local anesthetics are agents that reduce pain and sensation in a localized area of the body without loss of consciousness. The Merck Index of Chemicals and Drugs. A variety of drugs and chemicals are used in dentistry to aid in the diagnosis. 3-7. uses. average doses. SUPPLEMENTAL INFORMATION The following publications contain complete information on drugs. to include properties. General anesthetics are agents that produce a loss of consciousness. General Anesthetics. the name and amount of the agent used is always entered on the Dental Health Record.3-5. b. It is recommended that you learn the characteristics of the approximately 35 drugs listed. a. These are normally available for your reference in Army dental clinics. GENERAL. Bupivacaine (Marcaine®).

This blocks the passage of impulses to the brain from the area involved. such as epinephrine or levonordefrin (Neo-Cobefrin®). 3-8. all of the mandibular teeth are anesthetized by the blockage of nerve impulses at a point some distance away from the teeth. the anesthetic solution is placed near the mandibular foramen (where the inferior alveolar nerve trunk enters the mandible) to innervate the mandibular teeth.NOTE: Pharmaceutical manufacturers use color coding systems to assist clinicians in the identification of various anesthetics used in their practice. Topical anesthetics are applied to the mucous membrane or skin surface. to temporarily abolish a gag reflex. 3-9. b. or to relieve pain and discomfort of oral prophylaxis procedures. Topical anesthetics may be used to anesthetize the buccal mucosa at the site of injection. The concentration of vasoconstrictors. The area of the injection will have less tendency to bleed. The addition of vasoconstrictors to local anesthetics is beneficial for the following reasons: a. They penetrate through the surface layers of the mucous membrane or skin. either the rubber stopper in each cartridge or by colored rings around the cartridge. The toxic effect of the anesthetic is reduced since it is released into the general circulation more slowly. b. Topical. Topical anesthetics used most commonly are benzocaine and lidocaine (Xylocaine®). MD0509 3-6 . for example. VASOCONSTRICTORS IN LOCAL ANESTHETICS Local anesthetics usually contain a vasoconstricting drug. to relieve pain of certain lesions. The anesthetic is retained in the area longer. The local anesthetic is injected into the area next to the nerve trunk (a major undivided portion of a nerve trunk). c. In the mandibular block. contact the nerve endings. Thus. METHODS OF ADMINISTRATION OF LOCAL ANESTHETICS a. is identified by color coding. Block Anesthesia (Conduction Anesthesia). resulting in a greater time and depth of anesthesia. and produce a loss of pain and sensation. This technique is most commonly employed in the mandible where the density of the bone renders infiltration ineffective. It is advisable that the dental specialist become familiar with the different color coding systems.

the dental officer will prescribe an analgesic and instruct the patient in its use. Anesthetic being deposited (infiltration).c. The anesthetic then spreads to the nerve and passes through the nerve sheath. codeine preparations are effective in relieving mild to moderate pain in the majority of dental problems. NARCOTIC ANALGESICS a. Figure 3-1. Codeine. In dentistry. 3-11. Combined with other drugs such as aspirin or acetaminophen. Infiltration. The porous alveolar bone in the maxilla permits the anesthetic to spread to the nerves innervating the teeth. For this reason. Often the pain occurs after the patient has left the office and after the effects of the local anesthetic have worn off. ANALGESICS Analgesics are agents used to relieve pain. 3-10. They are classified as narcotic or non-narcotic and act chiefly to depress the pain systems of the nervous system. Codeine is an addictive narcotic derived from opium. See the appendix for examples of compounds containing codeine. MD0509 3-7 . When it contacts the nerve fibers. they become insensitive to pain and other sensations. infiltration is used most often to anesthetize maxillary teeth for procedures such as restoration and extractions. The local anesthetic is injected into an area that is to be surgically treated (see figure 3-1). The most common use of analgesics is for the relief of pain following oral surgical procedures. Differences in procedures and variations in patient response to pain require that a wide range of analgesic agents ranging from mild to potent be available to meet individual patient needs.

The percentage of nitrous oxide to oxygen is very important and is carefully monitored by the dental officer. NONNARCOTIC ANALGESICS a. antibiotics can be administered orally. The gases are supplied in cylinders. 3-12. erythromycin. 3-13.b. nonirritating gas that is non-explosive. It is not prescribed together with monoamine oxidase (MAO) inhibitor drugs. Antibiotics are used to combat infections by producing an effective blood level of the antibiotic and sustaining this level. It is used primarily in the hospital environment for relieving severe pain. Meperidine hydrochloride is sometimes prescribed for patients with moderate to severe pain who cannot tolerate codeine or morphine. and parenterally (see appendix). Morphine is a potent drug also derived from opium. colorless. Penicillin. general muscular aches. Depending on the type of antibiotic and the type of infection. Tylenol® (acetaminophen) has the same relative potency as aspirin and is used by some patients in place of aspirin. ANTIBIOTICS-GENERAL Antibiotics are agents that inhibit the growth of or destroy microorganisms. c. usually for 5 to 10 days. anti-inflammatory drug effective in the same situations as aspirin. Escaped gas during dental therapy may be hazardous to the dentist and dental specialist when exposure is chronic. Acetylsalicylic Acid (Aspirin). To reduce the potential for fires and explosions. It is used particularly by those patients who are allergic to aspirin or who cannot take aspirin for other reasons. It is a synthetic narcotic and has one-tenth the analgesic activity of morphine. Nitrous oxide cylinders are painted blue and oxygen cylinders are painted green. and mild to moderate pain. c. inhaler. INHALATION ANALGESIA AND SEDATION Inhalation analgesia and sedation using a nitrous oxide/oxygen combination is used more and more in dental therapy. but will support combustion. MD0509 3-8 . Meperidine hydrochloride is an important drug employed in dentistry. and reservoir for cracks and deteriorated rubber before each use. Motrin® (ibuprofen) is a non-steroidal. 3-14. Meperidine Hydrochloride (Demerol®). It has a mild sedative action and potentiates the action of other sedatives. Nitrous oxide is a sweet-smelling. Morphine. and tetracycline are the antibiotics most often used by dental officer. The dental specialist should check the tubing. oil or grease should never be used around this inhalation equipment. It is prescribed when there is temporomandibular joint (TMJ) and myofacial pain dysfunction (MPD). Aspirin (acetylsalicylic acid) is a widely used remedy for headaches. Acetaminophen (Tylenol®). b. Ibuprofen (Motrin®). topically.

Hypnotic and sedative agents are used in dentistry to relieve patient apprehension. induce sleep. and staphylococci (see the appendix). Patients with other allergies are more likely to be allergic to penicillin. PENICILLIN Penicillin is effective against gram-positive bacteria. such as streptococci. Erythromycin is relatively free of side effects. The dental specialist should review the patient's medical history to check for previous allergic reactions to penicillin.3-15. pneumococci. treat preoperative insomnia. TETRACYCLINE Tetracycline is a broad-spectrum. Normally. HYPNOTICS AND SEDATIVES-GENERAL Hypnotics and sedatives are agents that produce sleep or decrease excitability by depressing the central nervous system. Many people are allergic to penicillin and care should be taken to prevent prescribing it for these patients. 3-16. Tetracycline taken during these times may produce a permanent discoloration of teeth. 3-17. Small doses may produce a sedative effect. whereas larger doses may produce deep sleep (see the appendix). Both gramnegative and gram-positive bacteria are very common in the oral cavity. MD0509 3-9 . and is used in the treatment of most dental infections (see the appendix). 3-18. ERYTHROMYCIN Erythromycin is effective against gram-positive bacteria including beta hemolytic streptococci. gastrointestinal upset often occurs. the dental officer will not prescribe tetracycline to pregnant women during the last three months (last trimester) of pregnancy or to children under the age of 12 (tooth development period). The degree of potency and effect of the agent is dependent upon the amount used. Barbiturates and tranquilizers are two commonly used hypnotic and sedative agents. however. This antibiotic resembles penicillin in its spectrum of antibacterial activity and is used as a substitute for penicillin for hypersensitive patients or for organisms resistant to penicillin. antibiotic effective against gram-negative and gram-positive bacteria (see the appendix). and induce sleep in the presence of pain when combined with analgesics. mostly bacteriostatic.

Phenol was once used extensively for disinfection of the prepared tooth cavity prior to insertion of a restoration. TOPICAL ANTISEPTICS-GENERAL Topical antiseptics are agents that stop or inhibit the growth of microorganisms without necessarily killing them. Sodium Hypochlorite. This solution is used as a cleansing agent for suppurating (pus-producing) wounds and inflamed mucous membrane. c. d. 3-21. interactions with other medications. Topical antiseptics are applied to the oral mucosa for the control of minor infections and to root canals during endodontic therapy (see the appendix). e. and accidental or intentional overdosage. Phenol. MD0509 3-10 . 3-20. is often used for the irrigation of root canals. Gauze and ointments impregnated with iodoform are used as antiseptic dressings in extraction sockets. It has some antiseptic effect. it is used as a temporary restoration. (An example of a barbiturate is phenobarbitol. b. 3-22. They depress the activity of the brain. Hydrogen Peroxide (3%). Eugenol is a topical antiseptic and pain reliever. because of its solvent action on pulp tissue and organic debris. This solution. When mixed with zinc oxide. Iodoform. BARBITUATES These agents are grouped according to their duration of action. An example is camphorated parachlorophenol (CPC). Examples of tranquilizers used include hydroxyzine hydrochloride (Vistari®) and diazepam (Valium®). it is used in root canal therapy and as an antiseptic in mouthwashes. TRANQUILIZERS (ANTIANXIETY AGENTS) Tranquilizers (antianxiety agents) are used to relax and calm a patient without depression of mental faculties or clouding of consciousness (see the appendix).3-19. Eugenol (Oil of Cloves). producing sedation and sleepiness.) Possible problems associated with the use of barbiturates are psychic and physical dependence. COMMON TOPICAL ANTISEPTICS a. Today.

(3) Bonding resins and dentin adhesives. This is an effective topical hemostatic agent for capillary bleeding. b. DESENSITIZING AGENTS a. Resins and adhesives are now designed to flow into dentin tubules to seal the dentin surface when they are set. these materials have become very popular. Types of Desensitizing Agents. It is sometimes used in periodontal surgery in conjunction with a local anesthetic to reduce blood loss. HEMOSTATICS Hemostatics are agents that control bleeding. Epinephrine. 3-25. (2) Oxalates and varnishes. A reduction of dental caries is obtained by adding fluorides to the community water supply. When this material is implanted in tissues.3-23. Desensitizing agents are defined as drugs that alleviate painful sensations that sometimes occur in exposed dentin and cementum. With the newer systems becoming more adherent to dentin. Oxidized Regenerated Cellulose (Surgicel®). Definition. These materials can be used as liners under restorations. Fluoride is used in the treatment of hypersensitive dentin in the cervical areas of the tooth. b. Preparations include toothpaste. 3-24. restorative materials. It is used primarily to control capillary bleeding from within extraction sockets. stannous fluoride. mouth rinse. Both materials plug dentin tubules to prevent dentin sensitivity. Fluoride (in the form of sodium fluoride. by administering supplemental systemic fluorides. Absorbable Gelatin Sponge (Gelfoam®). and by applying topical fluorides directly to tooth surfaces. topical gel. a. FLUORIDE COMPOUNDS The effectiveness of fluoride compounds in lowering the incidence of dental caries is of utmost importance in the field of dental health. it promotes the disruption of platelets and acts as a framework for fibrin strands. and so forth) is used in many preparations. and many others. This is a topical hemostatic agent used to control moderate bleeding. MD0509 3-11 . acidulated-phosphate fluoride. (1) Fluoride. c.

ADMINISTRATIVE CONSIDERATIONS 3-28. including aspirin. Formocresol is used in root canal therapy as a tissue fixative and antibacterial agent between dental appointments. The indiscriminant use of any drug. This stimulant is used in the dental clinic to counteract a syncope (a brief loss of consciousness). These procedures must be followed in accordance with local SOP. the supply is adequate. 3-27. Vitamins are a small group of organic compounds that are essential in small quantities to the health and maintenance of the body. Aromatic ammonia spirit. is a reflex stimulant. CONTROL OF NARCOTIC ANALGESICS Control of narcotic analgesics is accomplished by exercising precaution in prescribing or administering these drugs. can be harmful. Tincture of benzoin is sometimes used as a protective and local soothing agent for lesions of the oral mucosa. This. Aromatic Ammonia Spirit. The dental specialist should ensure that he is competent and up-to-date in resuscitative procedures such as cardiopulmonary resuscitation (CPR). MISCELLANEOUS DRUGS a. in a normal diet. c. usually administered by inhalation.3-26. It is also used as a fixative in a pulpectomy. Vitamins. MD0509 3-12 . it is more convenient for the dental officer to write a prescription for narcotic medications to be filled by the pharmacy. Formocresol. although usually. Section III. is the responsibility of the dental officer. Tincture of Benzoin. Guidelines and regulations must be followed for controlling and dispensing drugs. Because of the records and reports involved in keeping narcotics. d. Vitamin supplements are sometimes indicated for a patient. GENERAL Drugs must be used with care. the dental specialist should be prepared for such events by being alert and knowledgeable. In addition. 3-29. of course. b. EMERGENCY KITS AND EMERGENCY AID Although life-threatening emergencies in the dental clinic are rare. He should ensure in advance that the drugs and equipment in the emergency kit are working properly. the dental specialist should know from which medical sources to obtain emergency aid. He should know exactly where to find the emergency kit that contains drugs and equipment used in emergency situations.

Schedule I substances have no accepted medical use in the United States. A prescription is a written order from an authorized individual to a pharmacist directing him to furnish a certain drug to a patient. Schedule V substances include cough syrups. medical usefulness. Schedule II. d. Schedule III substances may lead to moderate to low physical dependence. Schedule III. II. or V. MD0509 3-13 . This act establishes five schedules of controlled substances. and degree of physical or psychological dependence. Schedule II substances have an accepted medical use and have a high potential for abuse. Properly Prepared DD Form 1289. Examples of these substances are aspirin or acetaminophen compounds containing codeine (Tylenol #3 and Empirin with codeine). Examples of Schedule II substances are morphine. marijuana. designated as Schedule I. and lysergic acid diethylamide (LSD). and Percodan® (trade name).3-30. Schedule IV substances include sedative-hypnotics such as chloral hydrate and phenobarbital and tranquilizers such as diazepam (Valium®). e. PRESCRIPTION WRITING a. The appendix provides a listing of drugs commonly used in dentistry and describes some controlled substances that are not listed below as examples. However. codeine. Schedule III substances have a lower potential for abuse than those listed in Schedules I and II. General. simplicity. depending largely on the drug's potential for abuse. typed. A prescription should be stamped. Prescription writing should follow certain basic rules to ensure accuracy. Schedules IV and V. Examples of Schedule I substances are heroin. III. IV. or written legibly in ink without erasures on a properly prepared DD Form 1289 (DOD Prescription). FIVE SCHEDULES OF CONTROLLED SUBSTANCES a. c. Schedule III substances are classified as Code Q substances in the Federal supply system. Both Schedule IV and V substances are classified as Code K substances in the Federal supply system.) The prescription ensures proper control of substances since most substances are unobtainable without a prescription. and accountability. (See figure 3-2. Schedule I. General. Schedule IV and V substances have decreasing potentials for dependence and abuse than those in previous schedules. b. b. but have a high potential for abuse. 3-31. Schedule II substances are classified as Code R substances in the Federal supply system. The law that presently governs drug control and legal enforcement of drug laws in the United States is The Comprehensive Drug Abuse Prevention and Control Act of 1970.

Figure 3-2. age. c. A prescription must include the signature and social security number of the dental officer. A prescription should include directions for use. Prescriber Information. and organization or address. Patient Information and Date. Direction for Use. A prescription should include the date and the patient's full name. Oral instructions must be confirmed on the prescription. e. and other substances that may be hazardous are prescribed. A prescription should include the dose and the total amount of drug to be dispensed. The generic name or a suitable brand name may be used. Dose and Amount of Drug. the total amount should be limited to that required for the immediate course of treatment. MD0509 3-14 . d. A statement such as "use as directed" should not be used unless written instructions have been provided for the patient. f. The patient's age is particularly important if the patient is a child or if a strong dose is prescribed. When narcotics. Sample prescription. barbiturates.

SUPPLEMENTAL INFORMATION a. Pertinent Official Forms. DA Form 3949 (Controlled Substances Record). duties of dental officers. Composition. dental organization. Army Regulation (AR) 40-1.3-32. and functions of the Army Medical Department. Pertinent Department of the Army Regulations. outlines the composition. DA Form 3949-1 (Controlled Substances Inventory). and the application of narcotic licensing laws for dental officers. mission. Mission. and Functions of the Army Medical Department. (1) (2) (3) (4) DD Form 1289 (DOD Prescription). Continue with Exercises MD0509 3-15 . DA Form 3875 (Bulk Drug Order). Section II covers the composition of the Dental Corps. b.

MD0509 3-16 . c. b. None of the above. c. The action of a drug which is other than that specifically desired is a: a. The amount of a drug that causes death is a: a. The dosage range of a drug between the minimum dose. reread the material referenced with the solution. 3. or by writing the answer in the space provided at the end of the exercise. Side effect. turn to "Solutions to Exercises" at the end of the lesson and check your answers. is a: a. After you have completed all the exercises. b. Side effect. b.EXERCISES. For each exercise answered incorrectly. Toxic dose. c. Therapeutic dose. Side effect. LESSON 2 INSTRUCTIONS: Answer the following exercises by marking the lettered response that best answers the exercise. by completing the incomplete statement. 1. 2. d. and the maximum dose. Therapeutic dose. Toxic dose. Toxic dose. Therapeutic dose.

5. Topically. d. e. c. Nitrous oxide is administered: a. Sublingually. Topically. b. d. Subcutaneously. b. Subcutaneously. Orally.4. Nitroglycerin is most frequently administered: a. Intravenously. 6. Sublingually. c. d. e. Topically. MD0509 3-17 . Insulin is normally administered: a. By inhalation. By infiltration. b. Intramuscularly. c. Intramuscularly. e. By inhalation. Orally.

d. c. Usually less expensive than other dosage forms and usually easier to take are medications administered: a. By inhalation. Sublingually. e Sublingually.7. When a local anesthetic is injected near the target tissue and it diffuses and penetrates through the nerve sheath to the nerve fibers. Orally. b. By infiltration. b. Orally. Subcutaneously. When a drug is in an oily liquid or in suspension. b. Subcutaneously. the action of a drug can be prolonged if the drug is administered: a. By infiltration. Intravenously. MD0509 3-18 . d. c. 9. e. d. Topically. the local anesthetic is administered: a. Sublingually. Topically. By inhalation. c. Intramuscularly. e. 8.

Which of the following routes of administration of a drug is NOT parenteral? a. and so forth. and slightly elevated patches of skin. c. contraction of the bronchi. Match the description in Column I to the condition in Column II. Acute. Syncope. 12. caused by spasmodic c. Sedation. MD0509 3-19 . d. c. b. Transient loss of consciousness. with severe itching. smooth. eyelids. tongue. Angioneurotic edema. A spontaneous swelling of lips. d. life-threatening allergic reaction. Idiosyncrasy. (4) ____ (5) ____ 11. Intramuscular. soft palate. (1) ____ A reaction pattern of transient. Antidote.10. Analgesia. Difficulty in breathing. Subcutaneous. e. (2) ____ (3) ____ b. Topical. b. d. "The relief of pain without the loss of consciousness" is the definition of: a. Anaphylactic shock. Asthma. cheeks. Intravenous. COLUMN I: Description COLUMN II: Condition a. Urticaria.

Pharmacology. MD0509 3-20 . "An abnormal response to a normal drug dose" is the definition of: a. 16. c. Sodium pentothal is an: a. b. 15. Intravenous anesthetic. Ethrane is a: a. Idiosyncrasy. The __________ Index of Chemicals and Drugs. Local anesthetic. a. b. Sedation. The __________ to Pharmaceutical Specialties and Biologicals. Chemotherapy. 17. List two references available in Army dental clinics that provide complete information on drugs. General anesthetic. b. b. 14. c. Pharmacotherapeutics. b. d. "The study of the uses of drugs in the treatment of disease" is the definition of: a. Antidote. Inhalation anesthetic. Analgesia.13.

c. d. 19. Epinephrine. Maxillary teeth. Block anesthesia is used to anesthetize: a. Levonordefrin. The area of injection will have less tendency to bleed. c. b. 21. 22. List the local anesthetics most commonly used in Army dental clinics. The anesthetic is retained in the area longer. b. a. Local anesthetics usually contain a vasoconstricting drug. b.18. Mandibular teeth. c. Select the drug that is NOT a vasoconstricting drug. No. Ethrane. The anesthetic is released more slowly into the general circulation. Mepivacaine hydrochloride ( __________ ). b. Is it a requirement to annotate on the Dental Health Record (SF 603) the name and amount of each local anesthetic used? a. Bupivacaine ( __________ ). MD0509 3-21 . __________ hydrochloride (Xylocaine). The anesthetic results in a loss of sensation throughout the body. b. All of the following are reasons for this practice EXCEPT FOR: a. Yes. a. 20.

b. 26. Anti-inflammatory agents. Analgesics. MD0509 3-22 . Infiltration is used most often to anesthetize __________ teeth for procedures such as extractions and restorations. a. 24. Following oral surgical procedures. Local anesthetics. Tranquilizers. d. Hypnotics. which of the following is most commonly prescribed? a. a. Mandibular. Bupivacaine. Lidocaine (Xylocaine). 25. Tranquilizers. Maxillary. d. Select the drug that is NOT used as a topical anesthetic. Benzocaine. c. Hypnotics. b. c. e. Which class of chemical agents is used to relieve pain without dulling consciousness? a. c.23. Antibiotics. Analgesics. b. b.

Motrin. c. Empirin #3. d. Morphine. MD0509 3-23 . c. Nitrous oxide. b. Meperidine hydrochloride. Helium. c. Which of the following is used by patients who cannot take aspirin or who are allergic to aspirin? a. Demerol. b. 29. Oxygen. Cylinders painted blue that are used for inhalation analgesia and sedation contain: a. e. Which of the following is a synthetic narcotic analgesic with mild sedative action? a. e.27. d. Aromatic ammonia spirit. Sodium pentothal. Codeine. Chloral hydrate. 28. Acetominophen. b.

31. 32. b. Eugenol. d. Erythromycin. Which of the following is more effective against gram-negative bacteria? a. Tetracycline. b. e. c. Which of the following is used for organisms resistant to penicillin or as a substitute for penicillin for hypersensitive patients? a. Phenobarbitol. Formocresol. d. Tetracycline. c. Erythromycin. Darvon. Benzocaine. MD0509 3-24 . the dental specialist should review the patient's medical history for previous allergic reactions to: a. Erythromycin. When an antibiotic is needed.30. b. Oxycodone. c. Penicillin. Penicillin. d.

Stannous fluoride. Which of the following is/are an antianxiety agent? (More than one response may be correct. c. Tincture of benz MD0509 3-25 . Atropine. d. 35. b. c. e. Barbiturates. e.) a. d. Acetominophen. d. and pose a possible problem associated with accidental or intentional overdosage? a. Iodoform. b.33. Which of the following agents depress the activity of the brain. Diazepam. b. 34. Camphorated parachlorophenol. e. Erythromycin. Vitamins. Which of the following is used in root canal therapy and as an antiseptic in mouthwashes? a. Hydroxyzine hydrochloride. Epinephrine. produce sedation and sleepiness. c. Phenaphen #3. Sodium hypochlorite. Formocresol.

a. c. Phenol. Aromatic ammonia spirit. Tincture of benzoin. b. b. Oxidized regenerated cellulose. d. 38. Epinephrine. Which topical antiseptic is used as a cleansing agent for suppurating wounds and inflamed mucous membrane? a. c. c. Sodium fluoride. e. Hydrogen peroxide. Formocresol. Absorbable gelatin sponge. Eugenol. MD0509 3-26 . b. 37. 39. Sodium hypochlorite. Epinephrine. Nitroglycerin. Select the drug that is used in a dental clinic to counteract syncope. Vistaril. Which of the following is used in the treatment of hypersensitive dentin in the cervical areas of the tooth? a.36. c. e. Iodoform. Which of the following is a topical hemostatic used to control moderate bleeding? a. d. b. Acetylsalicylic acid.

b. c. Complete information related to emergency aid. Schedule III. The dental specialist should know exactly where to find the __________. c. b. Percodan is an example of a ___________ drug. a. d. Schedule II. d. Schedule IV and V. Schedule III. a. The dental specialist should ensure in advance that the __________ and __________ in the emergency kit are working properly. Schedule I. c. 41. Schedule I.40. Schedule IV and V. b. d. 42. Substances that have an accepted medical use but also a high potential for abuse are classified as: a. The dental specialist should be up-to-date in ___________. MD0509 3-27 . The dental specialist should know the __________ ____________ to go to for emergency aid. Schedule II.

d. 45. Tylenol #3 and Empirin #3 are __________ drugs. d. e. Atarax.43. d. Which of the following is classified as a Code Q substance in the Federal supply system? a. Atropine. Schedule III. MD0509 3-28 . 44. Which of the following is classified as a Code K substance in the Federal supply system? a. c. c. e. Schedule I. Morphine. b. Phenobarbital. Tylenol #3. Demerol. Schedule IV and V. c. Percodan. b. b. Empirin #3. a. Darvon. Phenol. Schedule II.

COLUMN I: Form Number COLUMN II: Title a. DA Form 3949-1. DOD Prescription. A prescription must include the signature and the __________ __________ __________ of the dental officer. 48. The __________ and the __________ __________ of drug to be dispensed should be included on the prescription.46. c. b. Bulk Drug Order. b. AR 40-2. Check Your Answers on Next Page MD0509 3-29 . 47. or written legibly in ink on a properly prepared __________ ___________. Controlled Substances Record. c. __________ __________. a. DA Form 3949. Match the title in Column II to the form number in Column I. The __________ name of the drug or a suitable __________ name may be used. d. d. Complete information related to prescription writing. AR 40-1. b. Controlled Substances Inventory. Which Army regulation covers the application of narcotic licensing laws for dental officers? a. DA Form 3875. A prescription should be stamped. (1) ____ (2) ____ (3) ____ (4) ____ DD Form 1289. typed.

9.SOLUTIONS TO EXERCISES. MD0509 3-30 . 15. 2. (para 3-4i) (para 3-4c) (para 3-4h) (para 3-4k) Physicians' Desk Reference Merck (para 3-5) (para 3-7a) (para 3-7a) (para 3-7b) 16. c b d c a e d b c (1) (2) (3) (4) (5) d a c b a b a b a (para 3-2c) (para 3-2a(1)) (para 3-2a(3)) (para 3-3g) (para 3-3h) (para 3-3d) (para 3-3a) (para 3-3c) (para 3-3e) c d e a b (para 3-4b) 11. 6. 12. 14. 3. 10. 5. 13. 17. 4. 8. 7. LESSON 3 1. 18.

21. 26. d. 33. e (para 3-20) a e c a b (para 3-22d) (para 3-22c) (para 3-23b(1)) (para 3-25c) (para 3-26a) MD0509 3-31 . 36.19. 32. 37. 35. 23. 30. 24. 28. 31. a b c d c b a c d e c a b e d c b Lidocaine Marcaine Carbocaine (para 3-8) (para 3-8) (para 3-9b) (para 3-9c) (para 3-9a) (para 3-10) (para 3-10) (para 3-11c) (para 3-12b) (para 3-13) (para 3-15) (para 3-17) (para 3-16) (para 3-19) (para 3-7b) 20. 39. 22. 34. 29. 25. 38. 27.

42. 47. total amount generic. 46. DOD Prescription dose. brand social security number (para 3-31) (para 3-32a(1)) c d a b 41. 45. 48. (para 3-32b) End of Lesson 3 MD0509 3-32 . 44. a b c d b b c d e a b c d a (1) (2) (3) (4) emergency kit drugs. 43.40. equipment medical sources CPR (para 3-27) (para 3-30c) (para 3-30c) (para 3-30d) (para 3-30e) (para 3-30d) DD Form 1289.

head injury. kidney disease. constipation Known allergy Codeine 30 to 60 mg q 4-6 Oral hrs 30 mg codeine. bronchial asthma Hypotension. head injury. nausea. fever 325 to 650 mg q 4 hrs Aromatic Ammonia Spirit Reflux stimulant Use to counteract syncope reaction Autonomic agent Reduce salivation Topical anesthetic As needed Inhalation None Significant Atropine Benzocaine 0. 325 mg Aspirin Oral Hypotension.6 mg Oral Topical Fast pulse. constipation Nausea. 325 mg Acetaminophen 30 mg codeine. Reye's Syndrome Peptic ulcer. fever ADULT DOSE As needed POSSIBLE SIDE EFFECTS None Significant CONTRAINDICATIONS None Significant DRUG Absorbable Gelatin Sponge Acetaminophen (Tylenol) Acetylsalicylic acid (Aspirin) CLASS Hemostatic ROUTE Topical Nonnarcotic analgesic Nonnarcotic analgesic 300 to 1000 mg q Oral 4 hrs Oral Allergy. toxic overdose. bronchial asthma Codeine with Acetaminophen (Tylenol #3 or Phenaphen #3) Codeine with Aspirin (Empirin#3 or Phenaphen #3) Moderate pain Narcotic analgesic Moderate pain Oral Nausea. anticoagulant therapy.APPENDIX DRUGS COMMONLY USED IN DENTISTRY INDICATIONS (USE) Control post-extraction hemorrhage To replace aspirin for mild pain.4 to 0. constipation MD0509 Appendix-1 . bronchial asthma Hypotension. Kidney and Liver nausea. Suppress gag reflex Minimum effective dose Bupivacaine Local anesthetic Infiltration and prolonged block anesthesia Narcotic analgesic Narcotic analgesic Moderate pain Injection Allergic response. head injury. dilated pupils Allergic response Pregnancy Allergy Produce As needed temporary loss of sensation on oral mucosa. disease toxic overdose Allergy. toxic depression Nausea. or teenagers with flu or flu-like symptoms None Significant Mild pain. children.

Oral Drowsiness. and provide hemostasis. or temporary restoration. dry mouth Use of alcohol. arrhythmias Pregnancy. if None Significant swallowed in large amounts Fluoride intake already optimum Fluoride Water additive Fluoride added Optimum to drinking concentration of water results in 1ppm in water teeth more resistant to decay Antibacterial agent in root canal treatment.000 to 1:250. hypertension.000 for IV or IM injection Topical Epinephrine Vasoconstrictor. Vistaril) Tranquilizer and Anxiety. seizures Topical Lung disease Toxic. preoperative sedation 50 to 100 mg. Tissue fixing agent in pulpectomy technique As needed Systemic Fluorosis of (oral) teeth (overdose) Formocresol Local antiinfective Topical Severe mucosal or periapical irritation Unable to isolate teeth Hydroxyzine hydrochloride (Atarax. narrow-angle Avoid alcohol. substitute for penicillin Injection (dental.i. operating vehicle. tension.5% for procedures 7 to 10 minutes Makes teeth more resistant to decay As needed Inhalation Hypotension. hyperthyroidism.i. tachycardia. q.d.d. preoperative sedation ADULT DOSE 2 to 10 mg 2 to 4 times per day ROUTE Oral POSSIBLE SIDE EFFECTS CONTRAINDICATIONS Drowsiness.000 with local anesthetics 1:1. Allergy.DRUG Diazepam (Valium) CLASS Sedative Hypnotic INDICATIONS (USE) Anxiety. Oral Gastric distress Allergy Ethrane Fluoride General anesthetic Topical Operating room 2 to 4. acute confusion. IV or IM) Systemic toxic reactions. sedative tension. or machinery Nausea Allergy Eugenol Nonnarcotic analgesic Mixed with ZnO As needed to make sedative base. Used in local adrenergic anesthetic to prolong anaesthesia. recent heart attack Erythromycin 250 to 500 mg. q. treatment of severe allergic reactions Antibiotic Infection. pupal analgesia In dilutions of 1:50. or machinery MD0509 Appendix-2 . glaucoma operating vehicle.

q 4 hrs Oral Head injury. constipation Known allergy 10-30 mg.000 retraction cord: also in local anesthetics to prolong anesthesia and provide hemostasis. MAO drugs. recent heart attack Lidocaine (Xylocaine) Topical anesthetic Topical Allergic response Allergy Lidocaine hydrochloride (Xylocaine) Meperidine hydrochloride (Demerol) Local anesthetic Infiltration and prolonged block anesthesia Narcotic analgesic Injection Allergic response. severe liver disease Mepivacaine hydrochloride (Carbocaine) Morphine (morphine sulfate) Local anesthetic Infiltration and prolonged block anesthesia Narcotic analgesic Severe pain Injection Allergic response. nausea Known allergy For severe pain 50 to 150 mg and as a q 4 hrs substitute for morphine Minimum effective dose Oral Head injury. Produce As needed temporary loss of sensation on oral mucosa. Minimum effective dose Injection Systemic toxic Known allergy. dizziness. nonsteroidal antiinflammatory agent Topical antiseptic Mild to 400 mg q 4-6 hrs: Oral moderate pain. toxic depression Dizziness. hypertension. toxic depression Nausea.DRUG Hydrogen perioxide (3%) Hydrogen peroxide (30%) Ibuprofen (Motrin) CLASS Topical antiseptic Oxidizing agent INDICATIONS (USE) Wound irrigation Vital and nonvital tooth bleaching ADULT DOSE As needed As needed ROUTE Topical Topical POSSIBLE SIDE EFFECTS N/A Chemical burns Gastric irritation and neophrotoxicity in high doses N/A CONTRAINDICATIONS N/A Unable to isolate teeth Allergy to iodine Oral analgesic. Use with caution tachycardia in pregnancy. TMJ and MFP 800 mg q 8 hrs dysfunction Impregnated gauze for post extraction alveoli As needed Topical Iodoform None Significant Levonordefrin (Neo-Cobefrin) Hemostatic vasoconstrictor Used with Dilution of gingival 1:20. hyperthyroidism. severe respiratory disease MD0509 Appendix-3 . reaction. bronchial asthma.

permanent discoloration of teeth. gram-positive organisms Irrigation of canal Mild pain Oral Allergy. Percocet) Penicillin 4. high potential for abuse Head injury. complex surgery Severe pain ADULT DOSE 15 to 75% ROUTE POSSIBLE SIDE EFFECTS CONTRAINDICATIONS Lung diseases Inhalation Hypoxemia Oxycodone or Oxycodoneride hydrochloride (Percodan. Avoid milk products and antacids Hypersensitivity Phenol Propoxyphene hydrochloride (Darvon) Topical antiseptic Synthetic narcotic analgesic As needed 65 mg Topical Oral Ticture of Benzoin Obtundent Irritated mucosal tissues N/A Topical End of Appendix MD0509 Appendix-4 . skin rash Contact dermatitis Hypersensitivity Should not take during pregnancy. disease toxic overdose Mucosal or skin irritation In utero or infancy.5 5 mg q 6 hrs with either 325 mg aspirin or 325 mg Acetamino-phen 500 mg q 4 hrs Oral Dizziness. Kidney and Liver nausea. or give to infants. severe respiratory disease Antibiotic Infection. sedation.DRUG Nitrous Oxide CLASS General anesthetic Narcotic analgesic INDICATIONS (USE) Extended.

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